According to this study:

* Delaying antibiotics in children with acute otitis media diminishes their unnecessary.

* Outcomes are comparable in "wait-and-see" and routine care.

Fifteen million prescriptions for antibiotics are written for U.S. children with acute otitis media (AOM) annually, yet untreated AOM often resolves naturally. Also, there are comparable rates of complications with or without antibiotics, which are associated when overused with the development of antibiotic-resistant microbes, a serious public health concern.

In a randomized, controlled study, researchers found that a "wait-and-see" approach substantially reduced the unnecessary prescription of antibiotics in children with AOM and was an effective alternative. "The whole concept of the study is to empower families and to have them work with the doctor to make a decision about whether or not to give an antibiotic," said principal study author David M. Spiro in an interview with AJN.

Researchers evaluated children with AOM six months to 12 years old who were brought to a pediatric ED between July 2004 and July 2005. The children (N = 283) were randomized to either a "wait-and-see" prescription (WASP) group (n = 138) or a standard prescription (SP) group (n = 145). Parents of patients in the WASP group were advised not to fill the prescription for antibiotics unless the child was not better or was worse 48 hours after the visit. All patients were given ibuprofen and otic analgesic drops.

Through telephone interviews with parents or patients at four to six, 11 to 14, and 30 to 40 days after enrollment, the researchers identified the proportion of each group that had filled the prescription within three days, the course of illness, the adverse effects of medication, the number of days of school or work missed, the number of unscheduled medical visits made, and the level of comfort with management of AOM without the use of antibiotics in the future.

Substantially more parents in the WASP group than in the SP group did not fill the prescription (62% and 13%, respectively). There was no statistically significant difference between the groups in the frequency of subsequent fever, otalgia, or unscheduled visits made for medical care for symptoms or complications of AOM. The patients in the WASP group whose parents had filled the prescription reported that they had done so because of fever (60%), otalgia (34%), or "fussy" behavior (6%).

In an accompanying editorial, Paul Little notes that "If parents are given clear information about the timing of antibiotic use and specific guidelines for signs and symptoms that should trigger reassessment, delayed prescribing probably has its place, should be acceptable to parents, appears reasonably safe, and provides a significant step in the battle against antibiotic resistance."

HL