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Otitis Media: Treat or Wait?

A wait-and-see approach safely reduced the number of prescriptions.

A long-standing concern is that many physicians overprescribe antibiotics for common upper-respiratory-tract infections — particularly acute otitis media (AOM). Results from prior studies conducted in office settings suggest that optional use of antibiotics is safe for some children. To examine a "wait-and-see prescription" approach, investigators randomized 283 children (age range, 6 months to 12 years) who presented to an urban emergency department with AOM to receive a standard prescription to be filled the same day or to be filled within 3 days if the patient was not better within 48 hours (wait-and-see approach). All patients received topical analgesics and ibuprofen.

In telephone interviews, significantly fewer parents in the wait-and-see group reported having filled the prescription than in the standard prescription group (38% vs. 87%). Reported rates of fever, otalgia, and unscheduled medical visits did not differ significantly between groups. Within the wait-and-see group, filling the prescription was associated with fever and otalgia.

Comment: As an editorialist nicely points out, increasing data suggest that the wait-and-see approach safely decreases overall antibiotic use. However, clinicians should limit this practice to the types of patients included in the trials: immune-competent children who appear non-"toxic," are at least 6 months old, and do not have perforations or tympansotomy tubes. Also, clinicians must take the time to explain this approach thoroughly and arrange for patient follow-up, especially in a busy emergency department.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine October 11, 2006

Citation(s):

Spiro DM et al. Wait-and-see prescription for the treatment of acute otitis media: A randomized controlled trial. JAMA 2006 Sep 13; 296:1235-41.

• Original article (Subscription may be required)
• Medline abstract (Free)

Little P. Delayed prescribing — A sensible approach to the management of acute otitis media. JAMA 2006 Sep 13; 296:1290-1.

• Original article (Subscription may be required)
• Medline abstract (Free)