[back] Antibiotics  Otitis Media

Antibiotics linked to recurrent ear infections

by Michael Woodhead

Young children with acute otitis media are almost three times more
likely to suffer from recurrent ear infections if they are treated
with antibiotics, research published in the BMJ today suggests.

In one of the first prospective long term studies of children with
acute otitis media, Dutch researchers followed up 168 children treated
by GPs for an episode of acute otitis media.

Half were randomised to received amoxicillin in three doses and half
to placebo.

While there was no difference in recurrence rates in the first year
after treatment, after three years the rates of recurrent otitis media
were 63% for the antibiotic group and 43% for the placebo group.

The researchers say this means a 20% higher risk of recurrent acute
otitis media with antibiotics was seen even after adjusting the
results for other factors, such as allergy and a previous tendency to
have recurrent ear infections.

However, they note that 30% of children in the placebo group had to
undergo ear, nose, and throat surgery on initial infection, compared
with only 21% in the amoxicillin group. They say the difference in
recurrence rates between the two groups could be due to antibiotic use
causing an ‘unfavourable shift’ towards the growth of resistant
bacteria. Early use of antibiotics might impair the natural immune
response and weaken protection against further episodes they argue.

And whilst antibiotics may reduce the length and severity of the
initial ear infection, their use may encourage doctors’ attendance in
future episodes and antibiotic resistance. “This is another argument
for judicious use of antibiotics in children with acute otitis media,”
they conclude.

3 July 2009