(Press-News.org) Using antibiotics to treat newly diagnosed acute ear infections among children is modestly more effective than no treatment, but comes with a risk of side effects, according to a new study designed to help advise efforts to rewrite treatment guidelines for the common illness.
Researchers found no evidence that name-brand antibiotics work any better in general than generic antibiotics and that careful examination of the eardrum by a clinician for signs of infection is critical for accurate diagnosis of acute ear infections. The study is published in the Nov. 17 edition of the Journal of the American Medical Association.
"Our findings reinforce the existing knowledge that the best antibiotic treatment for common childhood ear infections may be no antibiotic treatment at all," said lead author Dr. Tumaini R. Coker, a pediatrician at Mattel Children's Hospital UCLA and a researcher at the RAND Corporation, a nonprofit research organization.
"Prescribing antibiotics early may help cure ear infections a little bit faster, but also raises the risk that children will suffer antibiotic-related side effects such as a rash or diarrhea," Coker said. "Parents and their children may value these different outcomes differently."
Researchers from the Southern California Evidence-Based Practice Center conducted the study by examining previously published research about the diagnosis and treatment of acute ear infections among children. The review was requested by the American Academy of Pediatrics as part of its effort to update practice guidelines for treating acute ear infections among young children.
The study found that a major limitation of efforts to improve the treatment of acute ear infections is that there is no one definitive test for making the diagnosis. The use of an otoscope to look into the ear for signs of infection is a key component of any diagnosis and improving clinicians' ability to conduct this exam may help improve the accuracy of diagnosis, researchers said.
Acute ear infections are the most common childhood illness in the United States where antibiotics are routinely prescribed. A 2006 study estimated that it costs about $350 to treat each episode of the illness, with yearly national costs totaling $2.8 billion.
The new study reviews published data from 1999 to 2010 about the treatment of acute ear infections among children. This systematic review of the literature found that prescribing antibiotics early for acute ear infections had a modest benefit. Of 100 average-risk children with acute ear infections, about 80 would be expected to get better within about three days without antibiotics. If all were treated with antibiotics immediately at diagnosis, evidence suggests an additional 12 would improve, but three to 10 children would develop a rash and five to 10 would develop diarrhea, according to the study.
"Early prescribing of antibiotics offers a slight benefit and poses a slight risk," said the study's senior author, Dr. Glenn Takata, a pediatrician and researcher at Children's Hospital Los Angeles. "Clinicians will have to take these modest benefits and risks into consideration when deciding whether to treat with antibiotics or not."
Researchers also found no evidence that using newer, name-brand antibiotics to treat uncomplicated acute ear infections in normal-risk children offers an advantage over generic antibiotics, namely the commonly-used amoxicillin. Despite these findings, the higher-priced antibiotics are often prescribed for uncomplicated acute ear infections. Savings could be substantial if physicians used amoxicillin as the first line of defense against uncomplicated acute ear infections, according to researchers.
###
Funding for the study was provided by the U.S. Agency for Healthcare Research and Quality, which provides ongoing support to the Southern California Evidence-Based Practice Center. The center is based at RAND and the VA Greater Los Angeles Healthcare System.
Other authors of the study are Linda S. Chan and Dr. Mary Ann Limbos of the Keck School of Medicine of USC, Sydne J. Newberry and Marika J. Suttorp of RAND, and Dr. Paul. G. Shekelle of RAND and the VA Greater Los Angeles Healthcare System.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.
The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. To sign up for RAND e-mail alerts: http://www.rand.org/publications/email.html
END
Among the findings of an analysis of previous studies regarding ear infections in children are that results from otoscopic exams (an instrument for examining the interior of the ear) are critical to accurate diagnosis and antibiotics are modestly more effective than no treatment, with most antibiotics demonstrating similar rates of clinical success among children at normal risk, according to an article in the November 17 issue of JAMA.
Acute otitis media (AOM; middle ear infection) is the most common childhood infection for which antibiotics are prescribed in the United ...
A common transmissible strain of the bacteria Pseudomonas aeruginosa has been identified among cystic fibrosis (CF) patients in Canada, suggesting that cross-infection has occurred widely between CF centers in the United Kingdom and Canada, according to a study in the November 17 issue of JAMA. Infection with this strain among Canadian CF patients has been associated with an increased risk of death or lung transplantation.
There is variability in the type and timing of outcome among CF patients who are infected with P aeruginosa; some patients experience a rapid decline ...
Treatment of inoperable advanced liver cancer with the agent doxorubicin (routinely used to treat this condition) in addition to the agent sorafenib resulted in greater overall survival and progression-free survival, compared to patients who received treatment with doxorubicin alone, according to a study in the November 17 issue of JAMA.
"Hepatocellular [liver] carcinoma (HCC) is the sixth most common malignancy worldwide, with approximately 600,000 new cases per year. Patients with inoperable or metastatic disease have a median [midpoint] survival of only a few months. ...
Research from a six year study on migrating geese has discovered an interesting outcome – they return to the same spots they were taken to as youngsters.
The findings of the study, published online today [November 17] in the journal Molecular Ecology, suggest young light-bellied Brent geese learn their migratory destinations from parents.
This means their routes are learned through culture rather than inherited genetically, raising some interesting questions about why this species of goose demonstrates this behaviour.
Xavier Harrison, from the Centre for Ecology & ...
Heart imaging specialists at Johns Hopkins have shown that a combination of CT scans that measure how much blood is flowing through the heart and the amount of plaque in surrounding arteries are just as good as tests that are less safe, more complex and more time-consuming to detect coronary artery disease and its severity.
"Our findings should reassure cardiologists and patients that the newer, state-of-the-art CT scans are just as good as established older technologies in diagnosing the presence and severity of coronary artery disease," says cardiologist and lead study ...
Rolling back suggestions from previous studies, a Johns Hopkins study of 950 healthy men and women has shown that taking daily doses of a cholesterol-lowering statin medication to protect coronary arteries and ward off heart attack or stroke may not be needed for everyone.
In a study to be presented Nov. 16 at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, the Johns Hopkins team found that nearly 95 percent of all heart attacks, strokes or heart-related deaths occurred in the half of study participants with some measureable buildup of artery-hardening ...
WASHINGTON, D.C.—U.S. policymakers must focus more closely on developing new energy storage technologies as they consider a national renewable electricity standard, according to one of the principal recommendations in a newly released report, Integrating Renewable Electricity on the Grid, by the American Physical Society's Panel on Public Affairs (POPA). Establishing a national renewable electricity standard will help to unify the fragmented U.S. grid system—an important step in the wider adoption of using more wind and solar for energy generation.
But, without the focus ...
The types of gut bacteria that populate the guts of primates depend on the species of the host as well as where the host lives and what they eat. A study led by Howard Ochman at Yale University examines the gut microbial communities in great apes, showing that a host's species, rather than their diet, has the greatest effect on gut bacteria diversity. These findings will publish next week in the online, open access journal PLoS Biology.
"Bacteria are crucial to human health. They enhance the immune system, protect against toxins, and assist in the maturation and renewal ...
Keeping in close contact with heart failure patients once they leave the hospital has been an ongoing challenge for physicians. A patient's condition can worsen with no notice and early intervention could potentially make a big difference.
Researchers at Yale School of Medicine thought they found the solution with a telephone call-in program designed to improve doctor-patient communication. But results from their study published in the November 16 New England Journal of Medicine shows that this program failed to improve patient outcomes. The paper will be presented simultaneously ...
The nine-month pregnancy in humans is influenced by the structure of the placenta, according to new research into the evolution of reproduction in mammals which ends a 100-year mystery.
The study, by Durham and Reading universities, shows that babies grow twice as fast in the wombs of some mammals compared to others. The difference in growth rates appears to be due to the structure of the placenta and the way it connects mother and baby.
The research has found that the more intimate the connection is between the tissues of the mother and the foetus, the faster the ...
