Antibiotics are not linked to a significant decrease in fluid buildup
in the ear when administered to children with middle ear infections.
This is the conclusion of a meta-analysis of previous studies released
on February 18, 2008 in the Archives of Otolaryngology - Head &
Neck Surgery, one of the JAMA/Archives journals.
In infants and children, one of the most prevalent diseases is the ear
infection. Otitis media, or a middle ear infection, can lead to fluid
buildup in the middle ear, developing into acute otitis media with
effusion. According to the authors, this can be detrimental to
development. "The effusion may lead to a conductive hearing
loss of 15 decibels to 40 decibels, and this hearing loss could have an
adverse effect on language development, cognitive development, behavior
and quality of life."
Laura Koopman, M.Sc., of University Medical Center Utrecht, the
Netherlands, and colleagues examined data taken from 1,328 children,
ranging in age from 6 months to 12 years, with acute middle ear
infections. All had participated in one of five randomized controlled
trials comparing the use of antibiotics to a placebo or to not
treatment. Approximately half were assigned not to receive antibiotic
treatment.
44 percent of the children were younger than age two. Of these, 51.8
percent had repeated ear infections. In these groups, the risk of
developing middle ear effusion was highest. Antibiotics reduced the
risk of effusion to a statistically insignificant 90 percent of the
risk without them.
The authors caution against prescription of antibiotics in these cases.
"Because of a marginal effect of antibiotic therapy on the development
of asymptomatic middle ear effusion and the known negative effects of
prescribing antibiotics, including the development of antibiotic
resistance and adverse effects, we do not recommend prescribing
antibiotics to prevent middle ear effusion." Current treatment
guidelines agree with this assessment, as they do not recommend
prescription of antibiotics to prevent effusion.
The conclude, citing a need for further research. "However, more
research is needed to identify relevant subgroups of children who have
middle ear effusion that might benefit from other treatments," they
conclude.
Antibiotic Therapy to Prevent the Development of Asymptomatic
Middle Ear Effusion in Children With Acute Otitis Media
Laura Koopman, MSc; Arno W. Hoes, MD, PhD; Paul P. Glasziou, MD, PhD;
Cees L. Appelman, MD, PhD; Peter Burke, FRCGP, MRCP(Ire); David P.
McCormick, MD; Roger A. Damoiseaux, MD, PhD; Nicole Le Saux,
MD, PhD; Maroeska M. Rovers, PhD
Arch Otolaryngol Head Neck Surg. 2008;134(2):128-132.
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Anna Sophia McKenney