« MICU misdiagnosis | Main | Antibiotic soap? »

May 04, 2007

Ear infections

Ear infections are always a great concern of parents, who don't want to see their children suffer, and would do almost anything to help them. An old review, updated recently by Prof. Del Mar for BMJ, gives a picture not commonly understood by even most doctors.

Middle ear infections ( known as AOM-Acute Otitis Media) always get better, with or without treatment. There are few complications from AOM anymore (for whatever reasons), and antibiotics do not prevent them anyhow.

80% of children are better (at least out of pain) by the next day, regardless of treatment or not.

Starting an antibiotic early in the course would reduce the chance of pain by a third. IOW, from 20% to 14% (there's that relative risk reduction again). This means that 100 children would have to be treated to benefit 6, for a NNT (number needed to treat) of 17 for 1 to benefit by less pain days 2-7.

And if that were the whole story, we might all conclude that the cost and trouble of taking an unnecessary antibiotic would be worth it.

But what about the harm of antibiotics? The diarrhea, the abdominal pain, the rash? 30% So 5 of our 17 will be harmed in some way by the unnecessary antibiotic. To help one with pain, we harm five. Is that worth it? Some parents and doctors still think so. This concept is still just too foreign to most that it may not be worth the fight.

| By Robert Maddox | 10:20 AM

Comments

Another topic of interest is the effectiveness of childhood vaccines vs. the risk of vaccines. Much research has been done to help with raising my 5 kids. Most interesting were the numbers from epidemics that showed large percentages of those who came down with illness were properly vaccinated and had records. Most ridiculous now is the chickpox vaccine or the Hep B vaccine they try to administer to a newborn.

Posted by: Miki at May 5, 2007 10:01 AM

Robert, Fascinating blog! I got pointed here by Jon Amos' blog and I've found all of your articles so far very interesting. As a layman who, while understanding my lack of understanding of the medical field, is very skeptical of much of the corporate structure of modern medicine, I find it immensely helpful to have people on the inside analyzing the field in understandable language. Keep up the good work! In Caritas Christi, Matt

Posted by: Matt at May 6, 2007 03:55 PM

Thanks, I haven't even figured out how to comment on my own blog. Sorry for the delay. I have some vaccine info to post sometime. And I do hope this is in understandable language. Keep me so. Rob

Posted by: Robert at May 8, 2007 02:51 PM

Email "Ear infections" to a friend!

Email this entry to:


Your email address:


Message (optional):