Wait-and-see prescription may be all your child needs

There I was, in the middle of the night walking my baby, back and forth, as she screamed in pain, her face red with fever and exertion. If I held her close and continued walking and walking and walking some more, she might doze off. But heaven forbid I should stop, try to rest my exhausted body, because then she’d be awake and wailing again.

I knew she had an ear infection. I’m a doctor, after all, and I could peek with my otoscope. But it was the middle of the night, and this was in the days before all-night pharmacies graced the Spokane landscape. There was nothing I could do about it except give her Tylenol and wait until morning when the doctor’s office and the pharmacies opened. Then I could get a prescription. The Antibiotic Fairy would visit our house and we’d all get some much-needed sleep.

It turns out that all I may have needed was the Wait-and-See Fairy along with some ibuprofen and eardrops.

Ear infections in children, known as acute otitis media, or AOM, is the most common reason children get antibiotics. An estimated 15 million prescriptions are written annually for the treatment of AOM. But two recent studies have suggested that AOM is frequently a self-limiting disease, and antibiotics might not be necessary, especially if current treatment guidelines are followed and the child is given ibuprofen to treat the pain and fever and eardrops to numb the painful bulging eardrum.

These were not randomized studies. They were conducted out of doctors’ offices, and neither included the prescription eardrops. So, researchers at Yale University set out to study a group of children, aged 6 months to 12 years old, who were diagnosed with AOM over a year’s time in the pediatric emergency room of the Yale-New Haven Hospital.

Out of the 776 children diagnosed with AOM, 283 were included in the study. Of those, 138 were given a “Wait and See Prescription” group along with prescriptions for the ibuprofen and eardrops. Parents in this group were told not to get the antibiotics unless their child was either no better 48 hours after their visit, or was worse.

The second group, the Standard Prescription group, included 145 children. Their parents were told to fill the prescription for antibiotics and begin giving the medicine to their child right away. They also got the prescriptions for ibuprofen and ear drops and were given the same instructions: Use the ibuprofen every four to six hours as needed for pain or fever, and the ear drops every two hours as needed for pain.

Sixty-two percent of the WASP group did not fill their prescriptions, compared to 13 percent of the SP group (even though they were told to fill them). The parents who did fill the prescriptions said they did so because of persistent fever, ear pain or fussiness.

Ear pain lasted about half a day longer in the WASP group. Diarrhea, a common complication of antibiotics, was more common in the SP group, and among those children in the WASP group who used antibiotics. There were no bad outcomes in either group, and there was no difference between the groups in reporting of ear drainage, which might mean a ruptured eardrum.

This study showed a significant drop in the use of antibiotics in the wait-and-see group. Not every child with AOM qualifies for the WASP approach, but most do, and a WASP protocol could result in a large decrease in those 15 million prescriptions written each year. The WASP approach could save us money, reduce the cases of antibiotic-associated diarrhea and allergic reactions, and, most critically, slow the development of antibiotic resistance in the bacteria that attack us.

By giving parents a prescription to fill if necessary, they know they can call on the Antibiotic Fairy if needed. Otherwise, the Wait and See Fairy might be all they need.