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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, February 25, 2013

New Ear Infection Guidelines – Will Everyone Listen?

By Rod Moser, PA, PhD

ear check

The American Academy of Pediatrics (AAP) has just released their newly revised clinical practice guidelines for the treatment of otitis media (middle ear infections) in children. Whether clinicians will adopt those guidelines is any entirely different issue. The previous guidelines published in 2004, recommended that antibiotics should be used less often, and that certainly clinical criteria be met before treatment. Many clinicians embraced the recommendations, but others continued to do what they have always done: over-prescribe antibiotics regardless of the clinical findings.

As a medical culture, some clinicians will shell out antibiotics for just about anything. Every day, I see kids on antibiotics for “Strep throat” even though their Strep test was negative. Even though antibiotics are worthless for viruses (the #1 case of sore throats) clinicians still feel that an antibiotic would help. Did they miss that class in medical school? And, of course, the same goes for middle ear infections. In spite of strong empirical evidence that proves that antibiotics are rarely necessary for the management of middle ear infections, they keep prescribing it. I hear dozens of excuses, but a prevailing theme is that “patients are demanding them”. So…since when should patients in total control of treatment modalities? If this were the case, then amoxicillin would be over-the-counter. Parents should have some input on a treatment decisions, and not just to beg for antibiotics.

The overuse of antibiotics has created some huge problems. Not only are some good antibiotics no longer working as well, the kids are ending up in the operating room in growing numbers to get tubes. Notably, this is primarily an American phenomenon – a situation not seen as frequently in Europe where antibiotics for middle ear infections are used infrequently.

The European medical community has been withholding the early use of antibiotics for over two decades. A large Dutch study proved that the vast majority of middle ear infections in children will resolve on their own without the use of antibiotics. Many Americans clinicians read this landmark study and basically pooh-poohed it. However, over the last several years, Americans have been gradually coming aboard. Dozens of medical articles have been written over the last decade encouraging (even begging) clinicians to stop using so many antibiotics for treating a disease that is going to resolve anyway.

We can only hope that these newer guidelines will convert a few die-hards into more judicious use of antibiotics for children with middle ear infections. Our future depends on it.

Posted by: Rod Moser, PA, PhD at 11:39 am

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