Kids and Earaches

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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
                              

 

                        Reference
                        Wait-and-See Prescription for the Treatment of Acute
                        Otitis Media
                        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.
                        Arnold, MD,
                        MPH; James D. Dziura, PhD; Mark D. Baker, MD; Eugene D.
                        Shapiro, MD

                        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
                        withheld."
                        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
                        treatment strategy."
                        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
                        prescription."
                        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
                        information, visit
                        www.danmurphydc.com.