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June 28, 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 feel better by the next day, whether they are treated 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. That is iatrogenesis. Medicine is harming more than it helps.
Clinical Iatrogenesis | By Robert Maddox | 05:40 PM