Kids and Earaches
Friday, April 03, 2009
Kids and Earaches
Written by Dr. Dan Murphy, D.C.
TAC, Research Review , Volume 28, Issue 13
Published:november 28, 2006
Wait-and-See Prescription for the Treatment of Acute
A Randomized Controlled Trial
Journal of the American Medical Association
Vol. 296 No. 10, September 13, 2006, pp. 1235-1241
by David M. Spiro, MD, MPH; Khoon-Yen Tay, MD; Donald H.
MPH; James D. Dziura, PhD; Mark D. Baker, MD; Eugene D.
Key Points from Dan Murphy
1) "Acute otitis media is the most common reason for
which an antibiotic is prescribed to children,"
accounting for an "estimated 15 million antibiotic
prescriptions written per year in the United States."
2) "Untreated acute otitis media has a high rate of
spontaneous resolution, with similar rates of
complications whether antibiotics are prescribed or
3) "Resistance to antibiotics is a major public health
concern worldwide and is associated with the widespread
use of antibiotics."
4) The typical length of antibiotic therapy prescribed
for children with acute otitis media is a ten-day
course, and Amoxicillin is prescribed 92% of the time.
5) Diarrhea is the most frequently reported side effect
of taking antibiotics for acute otitis media.
6) Immediate treatment of acute otitis media with
antibiotics increases the rates of diarrhea by two to
three times, compared to the wait-and-see approach to
treating acute otitis media.
7) These authors showed that waiting to prescribe
antibiotics for acute otitis media is a "successful
8) This randomized controlled trial has shown that
waiting to use antibiotics for acute otitis media
"significantly reduces the use of antibiotics" without
compromising clinical results.
9) Most pediatricians in the United States are trained
to routinely prescribe antibiotics for acute otitis
media and "believe that many parents expect a
10) Only a "small minority of practitioners who care for
children routinely use watchful waiting" before
prescribing an antibiotic for acute otitis media.
11) "The risks of antibiotics, including
gastrointestinal symptoms, allergic reactions, and
accelerated resistance to bacterial pathogens, must be
weighed against their benefits for an illness that, for
the most part, is self- limited." [Very Important]
12) "The routine use of waiting to prescribe antibiotics
for acute otitis media "will reduce both the costs and
adverse effects associated with antibiotic treatment and
should reduce selective pressure for organisms resistant
to commonly used antimicrobials." [Very Important]
13) The waiting to prescribe antibiotics approach
"substantially reduced unnecessary use of antibiotics in
children with acute otitis media."
A 1978 graduate of Western States Chiropractic College,
Dr. Dan Murphy is on the faculty of Life Chiropractic
College West, and is the Vice President of the
International Chiropractic Association. For more