Delaying antibiotics is acceptable in otitis media

It is not clear whether acute middle ear infections (otitis media) should be treated with antibiotics. Some countries commonly use a 72 hour wait and see policy, but this strategy has not been subject to a randomised trial. Little et al (p 336) randomised 315 children to receive immediate antibiotics or to a wait and see policy. Immediate prescription provided symptomatic benefit but mainly after the first 24 hours, when symptoms were already milder. Benefits were balanced by disadvantagesa 10% increase in cases of diarrhoea, and increasing parents' belief in the importance of antibiotics. The authors conclude that, for children who are systemically well, a wait and see approach is feasible, acceptable to most parents, and substantially reduces the use of antibiotics.

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Relevant Article

Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media

Paul Little, Clare Gould, Ian Williamson, Michael Moore, Greg Warner, and Joan Dunleavey
BMJ 2001 322: 336-342. [Abstract] [Full Text] [PDF]