Antibiotics for pediatric ear infections - benefits and risks

Middle ear infections, known as acute otitis media (AOM), are the most common childhood illness in the US where antibiotics are routinely prescribed. According to a new study published in JAMA, using antibiotics to treat newly diagnosed acute ear infections among children is modestly more effective than no treatment, but causes adverse effects.


US researchers, requested by the American Academy of Pediatrics, to update practice guidelines for treating children's ear infections, reviewed 125 published previous on the effect of antibiotics and found that 80% of children with ear infections would recover within about 3 days without antibiotics. If all of the children were treated with antibiotics, an additional 12 would improve in 3 days, but 5 to 10% of the children would develop diarrhea.

They found no evidence that higher- priced antibiotics work better in general than generic ones and there is a wide variation in diagnosis and management of AOM, they suggested that using an otoscope may help improve the accuracy of diagnosis.

The authors concluded that doctors need to weigh the risks and benefits "before prescribing immediate antibiotics for uncomplicated AOM" and further research is needed.



Source: Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children - A Systematic Review. JAMA. 2010;304(19):2161-2169. (f/t via Athens)

Higher antibiotic doses to bigger people

Two doctors said in The Lancet Viewpoint, although drug treatments are tailored for individual patients, most dosing regimens, do not take patient's body size into consideration.

They argued that with increasing level of obesity worldwide, the standard dose of antibiotics for all adults is outdated because it may not be strong enough to clear the infection in taller and larger adults and resistance may be developed. Likewise, smaller patients may get too much drug, and suffer greater side-effects as a result.

They said that a patient's bodyweight should be taken into account when calculating their dose of antibiotics to achieve effectivenesss and safety.

Critics say that this review is based on authors' views and experience and is a valuable discussion. Changes to current prescribing would be costly and complicated, therfore further research and follow-up of previous study data would be needed.

Source:
"Adjustment of dosing of antimicrobial agents for bodyweight in adults". The Lancet, 375(9710):248-251

Editorial: "Prescribing medicines: size matters". The Lancet 2010; 375(9710): 172

Antibiotics won't prevent urinary tract infections in children

It is estimated that 70,000 to 180,000 children born in a given year will have urinary tract infection (UTI) by the age of 6.

According to a new study in the July 11 issue of the JAMA, "Recurrent urinary tract infection: risk factors and effectiveness of prophylaxis in a primary care cohort", researchers found 611 children had a first UTI and 83 had a recurent UTI, daily antibiotics may not prevent UTI from recuring in children and may increase the risk of drug resistance. A child's age and race may paly a role in the risk of UTI and being resistant to antibiotics.

This is the first large study of children diagnosed with UTI to estimate the effectiveness of antibiotices in a primary care setting. The researchers suggested that it is appropriate for physicians to discuss with parents the risks and unclear benefits of daily antibiotic treatment after a child has had a first UTI. Read the press release at Medical News Today.

Some pediatricians said the findings may change the practice for the better.