Otitis Media treatment by Ray Sahelian, M.D. Antibiotic treatment for acute otitis media

Otitis media means inflammation of the middle ear (the space behind the ear drum). Many different conditions are lumped together under the term otitis media - including infections due to a number of different viruses or bacteria, or the presence of different types of uninfected fluid. The presence of middle ear fluid and redness or inflammation of the ear drum is usually referred to as acute otitis media, is typically due to bacterial infection, and is usually treated with antibiotics. Chronic otitis media means long-standing middle ear fluid (with or without infection). Fluid in the ear, without signs of infection or inflammation, is usually called otitis media with effusion or serous otitis media.

Otitis Media Treatment - Antibiotic or no Antibiotic?
A wait-and-see approach that allows parents to decide if their child needs antibiotics for acute otitis media can reduce antibiotic use without adversely affecting outcomes. Previous studies investigating the value of a wait-and-see approach have excluded children with severe acute otitis media and have not been conducted in an emergency department setting, say lead author Dr. David M. Spiro, from the Oregon Health and Science University in Portland. The present study involved 283 children who were seen in an ER for suspected acute otitis media. The children were randomized to a wait-and-see prescription (WASP) group or to a standard prescription group. All of the children received ibuprofen and otic analgesic drops for pain control. With WASP, the parents were given an antibiotic prescription, but told not to fill it unless the child's condition had not improved in 48 hours. Parents in the standard prescription group, by contrast, were told to fill the prescription and have their child start taking the drug after leaving the office. Sixty-two percent of subjects in the WASP group did not have an antibiotic prescription filled compared with just 13% of those in the standard prescription group. Despite the difference in antibiotic use between the groups, clinical outcomes were similar. The occurrence of subsequent fever, otalgia, and unscheduled medical visits were not significantly different between the groups. Further analysis showed that fever and otalgia were predictors of filling the antibiotic prescription in the WASP group. In a related editorial, Dr. Paul Little, from the University of Southampton in the UK, comments: "If parents are given clear information about the timing of antibiotic use and specific guidelines for signs and symptoms that should trigger reassessment, delayed prescribing probably has its place, should be acceptable to parents, appears reasonably safe, and provides a significant step in the battle against antibiotic resistance." JAMA 2006;296:1235-1241,1290-1291.

Mastoiditis following acute otitis media
Antibiotic therapy for acute otitis media does not affect the subsequent development of acute mastoiditis.