Otitis Media: Treatment with Observation & A Safety-Net Antibiotic Prescription
Otitis media (OM) is an inflammation of the middle ear characterized by the accumulation of infected fluid in the middle ear, bulging of the eardrum, pain in the ear (otalgia), drainage of pus into the ear canal (otorrhea), fever and irritability 1 . Very little was known about ear disease until the 17th century. Otitis and draining ears were so common then, especially among the poverty of people, that they were considered a normal condition. Prior to the existence of antibiotics, ear infections and complications were primarily treated by surgical drainage 1 . Acute otitis media (AOM), one of the types of otitis media, is the most commonly treated bacterial infection in children and its treatment accounts for around 60% of pediatric antibiotic prescriptions 2-4 . Several studies have shown that there is little benefit to using antibiotics in most children with otitis media. Being that spontaneous resolution of AOM is between 70%-90%, theoretically only 1 in 7 to 14 children with AOM benefits from treatment with antibiotics 5-8.
Widespread use of antibiotics in the treatment of acute otitis media (AOM) has contributed to the prevalence of multidrug-resistant pathogens that are difficult to treat. It has been shown, however, that non-severe AOM in most children can be managed without antibiotics. This report describes a study where the parents of 194 children with AOM were given safety-net antibiotic prescriptions, only to be filled in case symptoms of AOM didn’t resolve within 48 hours by the use of analgesics and otic drops alone. The aim of this study was to evaluate and determine the safety, efficacy and suitability of non-antibiotic intervention for children with non-severe AOM. A subset of parents found that using safety-net prescriptions and pain control was acceptable in the treatment of AOM, and that antibiotic usage can be lowered with this strategy.