Health news
Health news top Health news

   Login  |  Register    
Health News Make AMN Your Home PageDiscussion BoardsAdvanced Search ToolMedical RSS/XML News FeedHealth news
  You are here : > Health Centers > Children's Health - Eye / Vision Problems -
Ear Infections: Treat All Kids Ear Infections: Treat All Kids

Ear Infections: Treat All Kids

Children's Health • • Eye / Vision ProblemsSep 04, 2013

All children younger than 2 with acute otitis media diagnosed according to current American Academy of Pediatrics guidelines should receive antibiotics, researchers said.

Among children age 6 months to 2 years with unilateral, nonsevere acute otitis media given amoxicillin-clavulanate, treatment failures were seen in 14% compared with failure rates of 40% in those given placebo, for an adjusted relative risk of 0.27 (95% CI 0.13-0.41), according to Alejandro Hoberman, MD, of the University of Pittsburgh, and colleagues.

In contrast, children with bilateral, severe otitis media - those for whom treatment currently is recommended - had failure rates of 25% with antimicrobial treatment and 59% with placebo, giving an adjusted relative risk of 0.34 (95% CI 0.18-0.48), Hoberman and colleagues wrote online in a research letter in JAMA Pediatrics.

“A recent American Academy of Pediatrics guideline recommends prompt antimicrobial treatment for children ages 6 months to 2 years with acute otitis media, with one exception: for children in whom the disease is unilateral and also unaccompanied by severe signs or symptoms, the guideline recommends, as an option, observation without initial antimicrobial therapy,” they observed.

However, that recommendation was based on studies that used diagnostic criteria that were less strict than the current requirements, opening the possibility that some treated children didn’t actually have acute otitis media.

To clarify this, the researchers pooled data from two previously published trials, one conducted in Pittsburgh and the other in Turku, Finland, both of which had stringent requirements for enrollment that came close to guaranteeing valid diagnoses.

The Pittsburgh trial defined treatment failure as inadequate symptomatic or otoscopic improvement by day 4 or 5 and incomplete resolution by days 10 to 12.

The Turku study defined treatment failure as a lack of overall improvement by day 3, no improvement in otoscopic findings by day 8, and the occurrence at any time of overall clinical deterioration, perforation of the tympanic membrane, or treatment discontinuation.

Action Points

  All children younger than 2 with acute otitis media diagnosed according to current American Academy of Pediatrics guidelines should receive antibiotics.
  Point out that the current study is based on a pooled review of studies among children 6 months to 2 year whose infection was unilateral and/or whose illness was non-severe showing that those treated with placebo had higher rates of treatment failure compared with those treated with amoxicillin-clavulanate.

Ear Infections- Treat All Kids The otitis media was classified as severe if the parents described the ear pain as moderate or severe or if the child had had a temperature of 39 degrees C.

In general, treatment failure rates were similar for severe and nonsevere disease and for unilateral and bilateral involvement.

For those with unilateral severe disease, treatment failure rates were 14% for the treated group and 47% for the placebo group, with an adjusted relative risk of 0.34 (95% CI 0.18-0.50), while the rates for bilateral nonsevere disease were 22% and 53%, respectively, for an adjusted relative risk of 0.31 (95% CI 0.14-0.48).

The numbers needed to treat were:

  Unilateral nonsevere, 4
  Unilateral severe, 3
  Bilateral nonsevere, 4
  Bilateral severe, 3

Ear Infections- Treat All Kids “These findings make a case for a uniform approach to antimicrobial treatment in children younger than 2 years with stringently diagnosed [acute otitis media], irrespective of laterality or apparent severity of their illness,” Hoberman and colleagues stated.

The study had no external funding. The authors reported no conflicts of interest.


By Nancy Walsh, Staff Writer, MedPage Today

Provided by ArmMed Media

Ear Infections: Treat All Kids Bookmark this! Ear Infections: Treat All Kids


We are pleased to let readers post comments about an article. Please increase the credibility of your post by including your full name and email.

All comments are reviewed by our editors before they are posted on the site. Just keep it clean, kids. Commenting is not available in this weblog entry.

   [advanced search]   
What health info have you recently searched for online?
Disease or condition
Exercise or fitness
Diet, nutrition or vitamins
None of the above

Get free support - Headache Causes, Symptoms, Diagnosis, and Treatment on

Health Centers


Health news

Health Encyclopedia

Diseases & Conditions

Drugs & Medications

Health Tools

Health Tools

   Health newsletter


   Medical Links

   RSS/XML News Feed


Add to Yahoo RSS News Feed

Google Reader


This website is accredited by Health On the Net Foundation. Click to verify. We comply with the HONcode standard for trustworthy health information:
Verify here.