Kids and Earaches

Wait-and-See Prescription for the Treatment of Acute Otitis Media
A Randomized Controlled Trial

Journal of the American Medical Association
Vol. 296 No. 10, September 13, 2006, pp. 1235-1241
by David M. Spiro, MD, MPH; Khoon-Yen Tay, MD; Donald H. Arnold, MD,

MPH; James D. Dziura, PhD; Mark D. Baker, MD; Eugene D. Shapiro, MD

Key Points from Dan Murphy

1) “Acute otitis media is the most common reason for which an antibiotic is prescribed to children,” accounting for an “estimated 15 million antibiotic prescriptions written per year in the United States.”

2) “Untreated acute otitis media has a high rate of spontaneous resolution, with similar rates of complications whether antibiotics are prescribed or withheld.”

3) “Resistance to antibiotics is a major public health concern worldwide and is associated with the widespread use of antibiotics.”

4) The typical length of antibiotic therapy prescribed for children with acute otitis media is a ten-day course, and Amoxicillin is prescribed 92% of the time.

5) Diarrhea is the most frequently reported side effect of taking antibiotics for acute otitis media.

6) Immediate treatment of acute otitis media with antibiotics increases the rates of diarrhea by two to three times, compared to the wait-and-see approach to treating acute otitis media.

7) These authors showed that waiting to prescribe antibiotics for acute otitis media is a “successful treatment strategy.”

8) This randomized controlled trial has shown that waiting to use antibiotics for acute otitis media “significantly reduces the use of antibiotics” without compromising clinical results.

9) Most pediatricians in the United States are trained to routinely prescribe antibiotics for acute otitis media and “believe that many parents expect a prescription.”

10) Only a “small minority of practitioners who care for children routinely use watchful waiting” before prescribing an antibiotic for acute otitis media.

11) “The risks of antibiotics, including gastrointestinal symptoms, allergic reactions, and accelerated resistance to bacterial pathogens, must be weighed against their benefits for an illness that, for the most part, is self- limited.” [Very Important]

12) “The routine use of waiting to prescribe antibiotics for acute otitis media “will reduce both the costs and adverse effects associated with antibiotic treatment and should reduce selective pressure for organisms resistant to commonly used antimicrobials.” [Very Important]

13) The waiting to prescribe antibiotics approach “substantially reduced unnecessary use of antibiotics in children with acute otitis media.”



A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit


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