Parents wanting antibiotics to aid their children's ear infections may no longer be able to get prescriptions easily after a crackdown on unnecessary treatments.
Fourteen medical authorities delivered 61 recommendations to Australian parents and doctors on Wednesday as part of a NPS MedicineWise campaign, Choosing Wisely. It included an urgent warning for children between 2 and 12-years-old with routine ear infections to avoid antibiotic treatment.
Other recommendations advise against routine antibiotic use for urinary tract infections, acne and a reduction -- where possible -- in antibiotic use for intensive care patients. Parents have also been advised to avoid using pain killers to treat fevers, with the recommendation arguing the drugs do not reduce the fever itself.
With many doctors around the country prescribing antibiotics to children -- and consequently their parents -- with sore ears, mothers and fathers would be forgiven for not welcoming the news with open arms and questioning why, only now, they shouldn't use the drugs.
Chair of the Royal Australian College of General Practitioners, Dr Justin Coleman, helped develop the recommendations. She spoke to The Huffington Post Australia to clear up some misconceptions for confused and deflated parents around the country.
Why are medical authorities recommending against using antibiotic treatment for ear infections in children?
"Generally a lot of doctors are prescribing and a lot of patients and parents are assuming that that’s the best treatment. The evidence isn’t saying we should never prescribe an antibiotic but it is saying we shouldn’t routinely be using an antibiotic because of an ear infection," Dr Coleman told HuffPost Australia.
“The main reason is because it doesn’t make a lot of difference. If it made a lot of difference it would be worth weighing that up against the side effects and resistance. But it doesn’t seem to make much difference to important long term outcomes like perforated ear drums or deafness or spreading infection."
While some ear infections can be viral in children -- and therefore not treatable with antibiotics -- Dr Coleman said antibiotics are not effectively working in bacterial ear infections, as the bacteria is often difficult for the antibiotics to reach.
“In the first day it doesn’t seem to make any difference. After a few days you can slightly decrease the child having pain but you have to treat twenty children with an antibiotic to prevent one on average having pain a few days later,” Dr Coleman said.
"Even with kids with a bacterial illness, the natural course of that illness is for the middle ear infection to cure itself anyway. The majority actually cure themselves with or without antibiotics.
"The typical child who walks into the GP for the first time with a sore ear and a red ear drum is actually better off not getting an antibiotic."
While antibiotic resistance is a contributing factor, Dr Coleman said the ineffectiveness of antibiotic treatment and pain relief in children's ear infection are the main reasons for the recommendation.
Why are doctors still prescribing antibiotics if the side effects outweigh the treatment?
"We haven’t always known it," Dr Coleman said.
"We’ve suspected this for quite a while -- perhaps 15 years -- and there’s been a lot of studies done. There’s been lots of trials in different populations around the world and lots of them in Australia as well.
"The collation of all those trials, they’re relatively recent and this is just one way of getting the message out there."
What should parents do instead to help their child cope with an ear infection?
"You do have to see a doctor to check there aren't any particular factors which stop it being 'routine', so you do need to get checked out," Dr Coleman said.
"We recommend, even if you’re not getting antibiotics, that the parent goes back to the doctor for review if there’s a suggestion that their child is not improving or getting sicker.
"That’s an important proviso if you’re not using antibiotics. Don’t sit at home and never see the doctor. You need a clinical history and examination and that’s where it can become safe not to use an antibiotic.
"With ear infections, it’s generally a self-limiting illness and you use just general pain relief, hydration of the child and rest and monitoring."
Why has it taken so long for the medical industry to come to this conclusion?
"I think what’s happened is we’ve overreached in the past with antibiotics, assuming that where you see infection you should see antibiotics. It takes a huge, well-controlled trial using placebos and large numbers of children. It takes a lot of effort and time to gather this evidence particularly when the differences in the treated and non-treated groups are quite small like they are with ear infection," Dr Coleman said.
"There’s a tendency to be overconfident that these treatments are doing the right thing and when evidence changes, practice changes. That’s one of the beauties of medicine."