Young children who are given antibiotics to treat acute ear infections are 20% more likely to suffer from recurrent ear infections, finds research published on bmj.com today.
This survey of parents whose young children took part in a Dutch trial of antibioitics for acute ear infections shows that nearly two thirds (63%) who were given antibiotics had a recurrence of the infection within three years. This compares with only a 43% recurrence rate in children who were given a placebo at the time of initial infection.
The study is the first to assess the long term effects of antibiotics in children with acute otitis media (ear infection) and supports calls for judicious prescription of antibiotics.
Acute otitis media is one of the most common infections in childhood and is the most frequent reason for children to take antibiotics. Current guidelines recommend prescribing antibiotics to children with severe illness and in those younger than two years of age with severe infection. For most other children with acute otitis media, initial observation is recommended.
The trial was conducted across 53 general practices in the Netherlands and included 168 children aged six months to two years of age.
In 2000, three and a half years after the start of the trial, parents of the participating children were sent a questionnaire asking if their child had suffered a recurrence of acute otitis media. In the amoxicillin group, 47 out of the 75 children had suffered at least one recurrent episode, compared with only 37 out of 86 in the placebo group.
This means that children in the amoxicillin group had a 2.5 times higher risk of recurrent acute otitis media than children in the placebo group.
The survey was likely to be unbiased because it included most (70%) of the parents, and because none of them had known at the time of the trial which treatment - either antibiotic or placebo - their children had received. The association remained even after adjusting the results for other factors, such as allergy and a previous tendency to have recurrent ear infections. It should be noted however 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.
The researchers suggest that the difference in recurrence rates between the two groups could be due to a weakening of the children's natural immune response system, as a result of taking antibiotics at the initial stage of infection. They argue antibiotic use may cause an 'unfavourable shift' towards the growth of resistant bacteria.
They also suggest that, 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.