Antibiotics for Acute Otititis Media: Benefits and Risks

Overview of Acute Otititis Media

Task:

Should Antibiotics Be use to Treat Acute Otitits Media Versus No Antibiotics  Patients who suffer from acute otitis media (AOM) have a rapid onset of symptoms, and signs and symptoms of middle ear inflammation. Nonspecific symptoms that are common in infants and young children are "rhinitis, irritability, headache, fever, anorexia, diarrhea, pulling at the ears, and vomiting" (Sparks, Berryhill, & Ramakrishnan, 2007, p. 1652).  It is essential to be able to distinguish between AOM which benefits from antibiotics verses otitis media with effusion which does not. The current research found is more focused on the latest development in understanding AOM and proper management, but the treatment goal in AOM does not change which includes symptoms resolution and reduction of recurrence.

Improper treatment of AOM can lead to severe complications especially for patients under two years of age. It has been a long-standing debate on whether antibiotics should be used to treat uncomplicated AOM. Multiple studies performed regarding the outcomes of giving versus not giving an antibiotic in AOM and have resulted in mixed reviews. Researchers have tried narrow the research, and in the attempt to categorize results using various materials and methods. "Characteristics that were considered as cofounders were gender, season of birth, parental education level, duration of exclusive breastfeeding, number of older siblings, household smoking, daycare attendance, age of first AOM episode and number of oral antibiotics prior to the first AOM episode"(Molder, Uiterwaal, Schilder, Damoiseaux, & Venekamp, 2016, p. 3). All of these factors play a big part in how many times the child is exposed to other germs and how often do they come in contact with certain bacterias and the cleanliness of the environments. No to mention how well the parents understand the instructions or discharge instructions as to how they will follow the medication regiment. Some parents are very poor historians and don't fully understand the diagnosis and treatment. Therefore, physicians always start with the first line therapy even though it will not help them Haggard (2011).

Amoxicillin is a medication that considered a mainstay of treatment for all ear infections by the American Academy of Pediatrics Treatment Guidelines as first-line therapy, and they recommend "80 to 90 mg per kg per day, given orally in two divided doses" (Ghosh & Chatterjee, 2017, p. 2). Some of the reasons why it is widely used amongst all physicians are due to it being safely tolerated well with no drug or food interactions, effective against all bacterial pathogens that cause acute otitis media. Also proven to be effective even in those populations with certain high resistant bacteria. Considered inexpensive at a reasonable cost along with a pleasant taste since we are dealing with children Leach and Morris (2006).

The Debate Over Antibiotic Use

Some studies suggest that "antibiotic treatment of AOM is linked to increases in future risks of AOM episodes by causing unfavorable shifts in microbial flora" (Song et al., 2016, p. 447). A majority of children who have been diagnosed with the bacteria Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis have spontaneous resolution within seven to 14 days. Kalyahakrishanan also agrees that "80 % of children with ear infections get better without antibiotics" (Sparks et al., 2007, p. 1653). Due to the spontaneous resolution and agreeance of multiple physicians, this is a reason why antibiotics are not prescribed routinely for initial treatment in all children. In some part of the United States, it does not matter if it is their initial AOM it is common practice to prescribe antibiotics Gamboa, Park, and Wanserski (2009). A majority of doctors usually like to wait 48 to 72 hours just to see if the ear infection will clear on its own and if not they require a follow-up. I have wondered why at times sometimes patients would get antibiotics and others wouldn't, or why one patient got one type and another a different type. Signs, symptoms, age, weight, and frequency play a vital role in deciding which direction the physician will take. If the child is afebrile and with minimal signs, the physician or nurse practitioner does not prescribe antibiotics.

For all patients who are younger than six months, it is always recommended to treat with antibiotics, those who are between six months to two years only when the diagnosis is precise. Passed the age of two years amoxicillin is recommended just for those who have a severe infection with otalgia and an elevated temperature greater than 102.2 F. Antibiotics are not given to healthy children between the ages of six months to two years who have been diagnosed with mild otitis in whom the diagnosis is uncertain."A Cochrane review of 8 randomized controlled trials (RCTs)-6 double-blinded, 2287 children total- compared antibiotics with placebo for uncomplicated AOM in otherwise healthy children. The report showed that children treated with antibiotics were no less likely to have pain at 24 hours after starting therapy than untreated children. However, 7% fewer children who received antibiotics had pain at 2 to 7 days than unmedicated children" (Gamboa et al., 2009, p. 603).

Research-based nursing is essential due to it being able to save time and money while improving patient outcomes by lowering costs, through standardizing and streamlining care. I believe with the formation of my question using Population Intervention Comparison Outcome Time (PICOT) I was able to identify the clinical issue systematically. In children with acute otitis media (P), ho is the use of no medication (I) more effective in reducing the duration of symptoms (O) as compared to a primary line therapy (C) within the first month of diagnosis (T)? With the use of electronic literature surveys on databases provided through the university online and internet searches, I was able to obtain information needed to answer my PICOT question. To narrow and make my research more relevant articles and information was used from the Cochrane Database of Systematic Reviews along with other library resources. Keywords and phrases such as acute otitis media, antibiotic use to treat AOM, comparison of efficacy and safety, adherence and guidelines, first episode of acute otitis media, and antibiotic resistance were used to help filter my searches. Additional filters used were ears nose and throat (ENT) and otitis to help narrow results. Cochrane Database of Systematic Reviews and university library databases resulted in multiple articles and used in this paper.