Tuesday, September 2, 2003

Ear pains clear without prescription

By Peggy O'Farrell
The Cincinnati Enquirer

More than two-thirds of parents in a Cincinnati study were happy with over-the-counter painkillers and "standby" prescriptions for antibiotics for their children's ear infections. Results were released today.

The findings could give doctors solutions for sick children, anxious parents and drug-resistant bacteria, said Dr. Robert Siegel, lead author of the study, which appears in this month's issue of Pediatrics.

"The hope is we can develop strategies to lower antibiotics usage so antibiotics remain effective when they're really needed," Siegel said. Ear infections are the most common reason for prescribing antibiotics to children.

Siegel is medical director of the Cincinnati Pediatric Research Group, which is affiliated with Cincinnati Children's Hospital Medical Center, and medical director of St. Luke Pediatric Centers.

The year-long study involved 175 children with ear infections from 11 pediatric offices. Families were given acetaminophen, ibuprofen and/or ear drops for pain control. They were also given prescriptions for antibiotics but told not to get the prescription filled unless symptoms got worse or didn't improve after 48 hours.

Just under a third of parents got the prescriptions filled.

Parents were "overwhelmingly willing" to stick with pain medication after the study, Siegel said. Almost 80 percent said the pain medication was effective, and 63 percent said they would be willing to skip antibiotics and stick with just pain medication for future ear infections.

Siegel said he was pleased by the results, "but I wasn't that surprised."

The Cincinnati study was based on a similar study in England, in which researchers cut antibiotic use 30 percent for ear infections.

But translating the study to the doctor's office will take some work. Most parents bring their children in with ear infections because the children are in pain, local pediatricians say. And parents have come to expect that they'll get antibiotics. Changing that will take a while, said Dr. Lisa Miller of Pediatric Care of Kentucky in Covington.

"Most people don't come to us the first second their ear starts to hurt," Miller said. "They've already been in pain for a day or two or three. Antibiotics are still the standard of care, and if I see someone who's in pain who has an ear infection, I'm going to prescribe an antibiotic."

Miller also points out that doctors and parents are going to have to consider whether the child is an infant screaming in pain, or older.

Siegel said parents seemed to like knowing they had options and the risks and benefits with those options.

"They do want to know what's going on and what's going to fix it," he added. "What we offered them (in the study) was pain control and reassurance, and the majority of children resolved on their own."

Most children don't need antibiotics to get over an ear infection, Siegel said. Studies show that only one in seven to one in 14 children benefit from antibiotic treatment of the ear, he said.


E-mail pofarrell@enquirer.com

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