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Study says antibiotics not always necessary



 
 
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Old September 18th 06, 01:15 PM posted to misc.kids.health
Roman Bystrianyk
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Default Study says antibiotics not always necessary

Tim Christie, "Study says antibiotics not always necessary",
Register-Guard, Eugene, Oregon, September 16, 2006,
Link:
http://www.registerguard.com/news/20...ion=cityregion

Doctors write more antibiotic prescriptions for ear infections than any
other childhood ailment - about 15 million a year in the United States
- even though 80 percent of ear infections will clear up on their own
if left untreated.

A new study led by an Oregon doctor may bolster the case for doctors
and parents to take a wait-and-see approach to ear infections, rather
than automatically turning to antibiotics.

"In this study, we found taking a wait-and-see approach is as safe,
effective and quick as antibiotics in resolving most childhood ear
infections," said Dr. David Spiro, the study's principal investigator
and assistant professor of pediatrics and emergency medicine at Oregon
Health & Science University.

Reducing the use of antibiotics in children is important because
antibiotic resistance has become a global public health concern, Spiro
said. When antibiotics are overprescribed, the bacteria they're meant
to kill can mutate and become resistant to drugs.

Spiro led the study, published in this week's Journal of the American
Medical Association, when he was practicing in the pediatric emergency
department at Yale-New Haven Hospital in Connecticut. He and his
colleagues examined 283 children from 6 months to 12 years of age
during a one-year period.

The children were randomly assigned to two groups: Parents of 145
children got a prescription for antibiotics and were told to fill it
immediately. The other group of 138 children received a "wait-and-see"
prescription, in which their parents were instructed to wait 48 hours
and to fill the prescription only if their child's condition was not
better or got worse. All patients were given medication for ear pain.

Spiro found that two-thirds of the wait-and-see group did not fill
their prescriptions and the children got better at the same rate as
children whose parents did fill the prescription. There was no
significant difference between the two groups in terms of fever, ear
pain or return visits for medical care.

Doctors don't change the way they practice medicine based on a single
study. But pediatricians say the study published in an influential
journal such as JAMA should make doctors and parents more comfortable
with the wait-and-see approach,

"I think it's another piece of the puzzle that will help in promoting
the appropriate use of of antibiotics for ear infections, which are the
most common reason a child ever receives an antibiotic," said Dr.
Richard Rosenfeld, director of pediatric otolaryngology at Long Island
College Hospital in Brooklyn and a spokesman for the American Academy
of Pediatrics on ear, nose and throat issues. "It may help increase the
popularity and acceptance of doing this among parents and other
doctors."

"I think it's a great study to reinforce to doctors as well as parents
that maybe antibiotics aren't needed nearly as often as we have been
prescribing them," said Dr. Tom Diehl of Oregon Medical Group's
Westmoreland Pediatrics in Eugene. "This gives us knowledge and
reassurance if we hold off for 48 hours, it will probably get better on
its own."

Most pediatricians were trained in medical school to treat all ear
infections with antibiotics. Before antibiotics were developed, about
20 percent of ear infections resulted in serious complications such as
mastoiditis, an infection of the mastoid bone in the skull, and
meningitis, an infection of the lining of the brain, Rosenfeld said.

The advent of antibiotic therapy in the 1940s and 1950s reduced those
complications to 1 or 2 percent, he said. Randomized trials conducted
in the 1960s found that antibiotics cured ear infections 90 percent of
the time, compared with 80 percent of cases that resolved without
treatment. That 10 percent margin made antibiotics the standard
treatment for ear infections, he said.

But that thinking began to change in 1990s amid concern about
drug-resistant bacteria.

"If we're dealing with a very common infection of childhood, in which
80 percent get better on their own, do we need to give every single
child antibiotics right away?" Rosenfeld said.

In 2004, the American Academy of Pediatrics and the American Academy of
Family Physicians released new clinical practice guidelines, which
recommend the wait-and-see approach for children 2 and older, who have
no pain or mild pain, and no high fever. It also recommended that all
children with ear infections be given ibuprofen or acetaminophen for
pain.

The JAMA study found that the wait-and-see approach is effective as
well on children as young as six months.

Persuading demanding parents to hold off on antibiotics can be
difficult, pediatricians say, but more parents now know antibiotics are
not always appropriate.

Dr. Jimmy Unger, a PeaceHealth Medical Group pediatrician, said he
finds that many of his parents already are educated on the dangers of
overprescribing antibiotics. "So it's usually not a hard sell to
convince them to watch and wait when that approach is appropriate," he
said.

"The biggest battle is convincing parents of the wait-and-see
approach," said Dr. Todd Huffman of McKenzie Pediatrics in Springfield.
"Parents are impatient and want treatment started now. It's easier to
hand out a prescription, but it takes time to explain the wait-and-see
approach."

 




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