September 15, 2006

Wait-and-see approach lowers antibiotic use: study

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Robert Whitehead, M.Sc., Ph.D., left, listens to Sir Nicholas Wright, M.D., Ph.D., D.Sc., at last week’s symposium.
Photo by Susan Urmy

Wait-and-see approach lowers antibiotic use: study

A new study suggests that taking a wait-and-see approach before giving antibiotics to children with acute ear infections results in significantly lower use of antibiotics, with little difference in outcomes for the children.

The study's results, published this week in the Journal of the American Medical Association, are particularly timely. Resistance to antibiotics is a major public health concern worldwide, and acute otitis media (AOM, or ear infection) is the most common reason for prescribing antibiotics to children, at a rate of approximately 15 million prescriptions per year in the United States.

The study, co-authored by Vanderbilt's Donald H. Arnold, M.D., M.P.H., tracked the emergency department visits of nearly 300 children ages 6 months to 12 years. Participants were divided into two groups — wait-and-see prescription (WASP), where parents had the option of delaying use of antibiotics, or standard prescription (SP).

Researchers found WASP significantly reduced the use of antibiotics: 62 percent of parents in that group did not fill the antibiotic prescription, compared with 13 percent in the SP group, resulting in an overall 56 percent reduction in antibiotic use. Although the WASP group had 2.4 days of earache versus two days in the SP group, there were no statistically significant differences between the groups in the frequency of subsequent fever or unscheduled visits for medical care.

“Acute otitis media is not the potentially severe disease it was 10-20 years ago, and our study should prompt physicians and parents to reconsider the need to treat these infections with antibiotics,” said Arnold, assistant professor of Emergency Medicine. “Pediatricians and Emergency Medicine physicians are seeing increasing numbers of children with other infections caused by bacteria resistant to available antibiotics, a phenomenon due in large part to the over-prescribing of antibiotics for upper respiratory infections, including acute otitis media. The most important effect of our study on medical practice may be a reduction in antibiotic overuse.”