Two studies published in the New England Journal of Medicine show slight decrease in recurrence of ear infections in children under 2 if antibiotics are given. The story quotes one expert saying the studies are “substantial” but also quotes a second expert who says the results are a “dubious way to say that everybody needs treatment.”
The story could have explored the shared decision-making encounter that parents could have with pediatricians based on this new evidence. By comparison, CNN’s story did a much better job helping parents with this angle.
Otitis media is the most common illness in children under 3 in the US. (75 percent of all children experience once by age 3.) Parents suffer, children suffer, and money is spent. If the treatment is only marginally effective, it would save parents and society money and time to avoid treatment.
At the same time, the problem of antibotic resistance is a huge financial and medical problem in the US.
In 2004, the American Academy of Pediatrics directly spoke to antibiotic resistance as a threat, and blamed frequent use in otitis media for some of that resistance.www.aap.org/sections/media/earinfection.htm
As stated above, we wish the story could have helped readers think more deeply about how/whether these data impact the decision-making process.
The writer did not give a typical cost for a couple of office visits and buying the antibiotic for otitis media treatment. The antibiotic used costs about $75 per treatment. Because the criteria used in both studies may be substantially more stringent than those used clinically for the diagnosis, the costs of office visits also must be considered.
In addition, the “cost” in the more abstract sense of how much antibiotic resistance “costs” society would have been a great addition to the story.
The writer does a good job of describing what one expert called the “dubious” benefit of avoiding treatment failure and continued infection for some untreated children.
Side effects of antibiotic use are mentioned in the very last sentence, but we think more detail was called for. For example, in the Pittsburgh study, 51% of the children treated with antibiotic developed diaper area rash (as compared to 18% in the placebo group) and 5% developed a fungal infection in the mouth (as compared to none in the placebo group). We welcomed the comment on resistant bacteria but the phrase should have been put into context. What are the implications?
The story quotes both experts who applaud the studies and an expert who questions their importance, an attempt by the reporter to analyze the evidence.
But the balanced difference of opinion still leaves the reader without any method of evaluating the quality of this evidence, in comparison to other studies. The story does explain that the definition of the infection is narrower in these studies, and expert Anthony Fauci is quoted saying that makes them “substantial.” Maybe more from Fauci would have helped explain this.
Overall, a credible job in describing the state of the art.
Credit to this writer for avoiding any mention of dire consequences for middle-ear infections. There can be some, but they are rare.
The reporter does contact sources who did not participate in the two research studies under discussion. He does not identify any larger potential conflicts for these experts, such as participation in pharmaceutical research on antibiotics.
If children are not treated with antibiotics immediately, they can receive what is called a “wait and see” approach from their pediatrician. The story does mention this.
Not applicable. Antibiotics are widely available. The story does not need to say this.
We’ll give the story credit for using Dr. Fauci’s summary of what made these studies different from past research: ”
“In many cases, [the children] had something that looked like otitis media but really wasn’t,” he said. The new studies “had really precise criteria to be eligible for enrollment,” which makes them “substantial studies.”
There is good original reporting and use of sources in the story.