As middle ear infections increase during the winter months, researchers from Israel’s Ben-Gurion University of the Negev (BGU) suggest that in many cases the most appropriate treatment is “watchful waiting” rather than immediate administration of antibiotics.

They indicate that watchful waiting could substantially reduce the use of antibiotics in the treatment of Acute Otitis Media (AOM) and play a major role in helping fight the development of treatment-resistant bacteria, noting that they find high resistance rates among AOM pathogens in children.

Their study, published in the scientific journal Expert Review of Anti-Infective Therapy, does not suggest use of watchful waiting in all cases when the infection is suspected by a pediatrician. However, it notes that a large majority of cases can be treated this way with no long-term ill effects.

Problems with the norm

Currently, watchful waiting is recommended for children over six months of age with mild to moderate symptoms or an uncertain AOM diagnosis.

“For years, antibiotic therapy was the norm for any child presenting with AOM symptoms,” says Dr. Eugene Leibovitz, lead author of the review, who is a BGU professor and works in the Pediatric Infectious Diseases unit at Soroka University Medical Center.

“However, we soon learned that there are problems with this strategy. While the antibiotics were killing off most of the AOM-causing bacteria, the few bacteria that managed to survive have developed resistance to that treatment.”

Discouraging resistant strains

The review notes that since the introduction of a polysaccharide conjugate vaccine to prevent infections from seven serotypes of the bacteria named Streptococcus pneumoniae, the number of AOM infections associated with these bacteria has decreased. However, AOM infections from bacteria not covered by the vaccine are on the rise.

A new vaccine that prevents infections caused by 13 serotypes of S. pneumoniae was recently introduced in routine use in many countries.

“Appropriate antibiotic treatment and vaccine-resistant bacteria remain a problem in managing children with AOM,” says Leibovitz, concluding that, “With selective guidelines-recommended use of antibiotic therapies and employing watchful waiting in non-critical cases, hopefully, we can discourage the emergence of other treatment-resistant bacterial strains.”