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

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.