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When are antibiotics appropriate for ear pain?

When are antibiotics appropriate for ear pain?


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Too many antibiotics are prescribed in Germany

Based on 1,000 patient years in Germany, there are 560 antibiotic prescriptions in the age group up to 18 years. Professor Johannes Liese from the Würzburg University Clinic found this number at the congress for pediatric and adolescent medicine in Cologne to be significantly too high. In the Netherlands, however, 294 prescriptions are enough. According to Liese, there are many unnecessary antibiotic treatments, especially in acute otitis media.

A Cochrane study was already dealing with the topic: "Wait for acute otitis media (AOM) or give an antibiotic?" Both with placebo and with antibiotics, 60 percent of all children had recovered within 24 hours after the start of therapy. Although there were some differences between the placebo and antibiotic groups in the further course of the disease, no differences in tympanometry, perforation of the eardrum or recurrence could be found after three months after treatment.

For whom is antibiotic treatment useful at AOM?

Overall, only a small antibiotic effect regarding pain and healing of acute otitis media in children was found. An analysis of the individual patient data showed that especially children under 2 years with bilateral acute otitis media or AOM and ear flow (otorrhea) can benefit from antibiotic therapy.

Why is AOM prescribed antibiotics so often?

According to Professor Liese, the hope of many doctors to shorten symptoms such as pain and fever, to avoid complications and to reduce the ability to infect is often unfounded. Although the regulation is well-intentioned, the fact stands in opposition to the fact that antibiotics have no or only minor clinical effects in some of these infections, naturally, especially in the case of viral ones. In addition, the direct side effects and the influence on the microbiome and development of resistance should be considered.

Antibiotic treatment only makes sense in one in 200 children with AOM

According to Liese, 200 children would need antibiotic treatment to prevent pain in one child. On the other hand, it is statistically seen that with this number of antibiotic treatments in 14 children, an episode with diarrhea, vomiting or rash occurs.

Antibiotics can be tolerated at AOM in young children

According to Liese, the use of antibiotics in children between the ages of six and 23 is acceptable if the diagnosis is questionable. Beyond the second year of life, if the course of acute otitis media is not severe, it can initially only be monitored.

In some constellations, antibiotics are essential

According to Liese, a general renunciation of antibiotics in the treatment of AOM is not advisable. In some constellations, antibiotic treatment is essential if, for example, additional factors such as immunodeficiency, craniofacial malformations, cochlear implant or recurrent AOM occur or the child is younger than six months. The presence of warning signs of complications in the sense of vomiting, inadequate fluid intake, redness, swelling or pain in the throat over the mastoid, vertigo, facial paresis, hearing impairment for more than a week also necessitates the use of an antibiotic. (fp)

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