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Wait-and-See Antibiotics for Otitis Media in the ER

Waiting 2 days before filling a prescription reduced antibiotic use without apparent complications.

Withholding antibiotics in children with acute otitis media (AOM) for 2 to 3 days to allow the possibility of spontaneous resolution has been shown to markedly reduce the use of antibiotics without serious complications (Journal Watch Jun 21 2005), but the trials were conducted in office settings, where continuity may be more likely than in emergency departments (EDs). In this study, investigators randomized 283 children (age range, 6 months to 12 years) seen in an ED for AOM to receive an antibiotic prescription either to be filled immediately, or to be held for 2 days to assess whether the child improved spontaneously. Children with complications (e.g., considered "toxic" by clinicians) were excluded, but children with severe AOM were included. All subjects received ibuprofen and otic analgesic drops.

Based on three blinded telephone interviews with parents or guardians, prescriptions were not filled for 62% of the wait-and-see group and 13% of the fill-immediately group. Intention-to-treat analyses revealed no differences between the groups in any clinical outcomes (e.g., otalgia, fever, unscheduled follow-up visits). Roughly two thirds of parents in the wait-and-see group who did not fill their children’s prescriptions would be willing to use the same approach during a future episode.

Comment: These results extend the concept of watchful waiting in acute otitis media to the emergency department and to children with severe AOM. Parents were reasonably accepting of this approach, although some parents and physicians opted not to participate in the study for reasons that would be worth studying further.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine September 12, 2006

Citation(s):

Spiro DM et al. Wait-and-see prescription for the treatment of acute otitis media: A randomized controlled trial. JAMA 2006 Sep 13; 296:1235-41.

• Original article (Subscription may be required)
• Medline abstract (Free)

Little P. Delayed prescribing — A sensible approach to the management of acute otitis media. JAMA 2006 Sep 13; 296:1290-1.

• Original article (Subscription may be required)
• Medline abstract (Free)