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LETTERS: Veli-Pekka Joki-Erkkilä, Juhani Pukander, Erdem I Cantekin, Kristian Roos, Stig Holm, and Eva Grahn Håkansson Streptococci and recurrences of otitis media BMJ 2001; 322: 1543 [Full text]

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Is best choice of antibiotic "no antibiotic"?

John Goldsmith   (26 June 2001)

Re: Is best choice of antibiotic "no antibiotic"?

Andrew Falloon   (27 June 2001)

Is best choice of antibiotic "no antibiotic"? 26 June 2001
John Goldsmith, Consultant Paediatrician Wanganui, New Zealand Send response to journal: Re: Is best choice of antibiotic "no antibiotic"?	Dr Joki-Erkkilä and Professor Pukander give yet another reason to question the need for any antibiotic in treatment of most otitis media. The suggestion that broad-spectrum antibiotic treatment may predispose to recurrences, together with the existing information regarding increasing microbial resistance, frequent adverse reactions to medicines, lack of convincing proof of efficacy, and cost to the health services of unnecessary medicines, makes it imperative that "no antibiotic" is a recognised option for treatment. Existing public information sheets, treatment guidelines, and Medical School / Continuing Medical Education teaching programmes should be amended to address this as a matter of urgency. I have no competing interests to declare.
Re: Is best choice of antibiotic "no antibiotic"? 27 June 2001
Andrew Falloon, GP locum, Christchurch, New Zealand GP locum Send response to journal: Re: Re: Is best choice of antibiotic "no antibiotic"?	I completely agree with Dr Goldsmith's comments. There seems to be no public knowledge about the lack of efficacy of antibiotics for otitis media, therefore most parents still expect a prescription for antibiotics when most of the time they would be of little benefit. Education amongst GPs locally seems to be little better - as a GP locum it seems that the vast majority of otitis media is treated with antibiotics, and the possibility of deferring treatment or avoiding them is not even discussed. I comment on this, having worked in the UK as a GP - they seem to be aware there of the evidence that antibiotics, in most cases, produce little or no benefit in otitis media, and do little to prevent the long- term complications.