When are antibiotics appropriate for earache?

In Germany too much antibiotics are prescribed

Based on 1,000 patient years, there are 560 antibiotic prescriptions in Germany in the age group up to 18 years. Professor Johannes Liese of the University of Würzburg found this number to be too high at the Congress for Pediatric and Adolescent Medicine in Cologne. In Holland, on the other hand, 294 prescriptions can be obtained. Especially in the case of acute middle ear infection, also called otitis media, there are too many unnecessary antibiotic treatments, according to Liese.

A Cochrane study was already looking at the topic: "Wait for acute middle ear inflammation (AOM) or give an antibiotic?" Both on placebo and antibiotics, 60 percent of all children had recovered within 24 hours of starting therapy. Although there were some differences between the placebo and antibiotic groups during the course of the disease, there were no differences in tympanometry, tympanic membrane perforation or recurrence after 3 months of treatment.

Children under 18 years often get unnecessarily prescribed antibiotics for acute middle ear infections. (Image: athomass / fotolia.com)

For whom is an antibiotic treatment at AOM useful?

Overall, only a small antibiotic effect on pain and healing of acute otitis media in children was found. An analysis of the individual patient data showed that especially children under 2 years with bilateral acute otitis media or AOM and otorrhea (otorrhea) can benefit from the antibiotic therapy.

Why is antibiotics prescribed for AOM so often??

According to Professor Liese, the hope of many physicians to shorten symptoms such as pain and fever, to avoid complications and to reduce contagiousness, is often unfounded. Although the regulation is well-intentioned, the fact remains that antibiotics have little or no clinical effects on some of these infections, especially those of viral origin. In addition, the direct side effects and the influence on microbiome and development of resistance should be considered.

Antibiotic treatment only useful in one in 200 children with AOM

According to Liese, 200 children would need to be treated with antibiotics to prevent the pain of a child. On the other hand, statistically speaking, with this number of antibiotic treatments in 14 children, there would be an episode of diarrhea, vomiting, or rash.

In infants, antibiotic treatment is acceptable in AOM

According to Liese, the use of antibiotics is justifiable for children between the age of six and 23 months if the diagnosis is questionable. On the other side of the second year of life, in the case of non-severe courses of an acute otitis media, it is only possible to observe it observationally.

In some constellations, antibiotics are indispensable

A general waiver of antibiotics in the treatment of AOM is not advisable according to Liese. In some constellations antibiotic treatment is indispensable if, in addition to the AOM, additional factors such as immunodeficiency, craniofacial malformation, cochlear implant or recurrent AOM occur or the child is younger than six months. Also, the presence of complications related to vomiting, inadequate fluid intake, redness, swelling or knocking over the mastoid, vertigo, facial paralysis, hearing impairment for more than a week, require the use of an antibiotic. (Fp)