Study: Don't cut back antibiotics for ear infection in kids

In the age of rising drug-resistant bacteria and superbugs, many doctors search for methods to avoid antibiotic overuse.

However, a new study shows reducing the duration of antibiotics in treating young children with middle ear infections is not the answer. The study suggests such treatment is actually ineffective.

The results come from a trial at the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC.

The results were published Wednesday in the New England Journal of Medicine and involved monitoring 520 children with bacterial ear infections. Next to the common cold, ear infections are the most common illness afflicting children in the United States.

Three of four children get ear infections, medically known as acute otitis media, within their first year, researchers said. As a result, it is the most common reason for prescribing antibiotics to children.

In the trial, children were given a standard 10-day regimen of amoxicillin antibiotics or a five-day treatment with a subsequent five-day placebo. The doctors and participants did not know which group each patient was assigned to.

Researchers found the treatment failed 34 percent of the time in the five-day group, more than double the 16 percent failure rate in the 10-day group.

“I hope that going forward, nobody will mess around with a five-day treatment when it comes to children under 2 years old,” said the study's lead author, Dr. Alejandro Hoberman, chief of the Children's Hospital division of general academic pediatrics. “We settled this question in a clear way.”

He said doctors still should avoid randomly prescribing antibiotics unless ear infections are properly diagnosed.

Sometimes, young children have a lot of wax in the ear canal, which prevents proper diagnosis without further examination.

“It takes extra work to be right,” Hoberman said. “But we as doctors need to be very accurate in how we diagnose.”

The trial ran from January 2012 through September 2015 at Children's Hospital, affiliated pediatric practices and Kentucky Pediatric and Adult Research in Bardstown, Ky.

When researchers tested patients for the presence of antibiotic-resistant bacteria by swabbing the back of the nose, they did not detect any decrease in the five-day group.

“The results are counterintuitive to what common belief would be,” Hoberman said. “The benefits of the 10-day regimen greatly outweigh the risks.”

Additionally, reducing antibiotics did not decrease the risk of common adverse reactions like diarrhea or diaper rash, according to the study.

“The difference in outcome between the two treatment groups also was large enough to show that standard-duration treatment was superior in efficacy to reduced-curation treatment,” Hoberman wrote in the New England Journal. “The strengths of our study include the limitation of enrollment to children younger than 2 years of age, which is the age group that is most prone to having treatment failure and recurrence of acute otitis media.”

Ben Schmitt is a Tribune-Review staff writer.