Children with ear infections recover just as well when their parents wait 48 hours before filling a prescription — a finding that could help curb unnecessary use of antibiotics.

Ear infection — acute otitis media — is the most common reason that antibiotics are prescribed to children.

Evidence suggests the drugs may not be needed, and overuse of antibiotics can lead to antibiotic-resistant bacteria. The medications also carry risk of reactions such as vomiting and diarrhea, and potential allergic reactions.

In a new study, researchers in the U.S. randomly told parents of 238 children with ear infections to either wait 48 hours before filling an antibiotic prescription or to do so the standard way.

Of the parents who were told to wait, two-thirds never filled the prescription, but their children recovered at the same rate as those who sought the drugs immediately, the team at Yale University School of Medicine reported in Wednesday's issue of Journal of the American Medical Association.

The children were between six months and 12 years old when they went to emergency departments for treatment, and they were all given the anti-inflammatory ibuprofen and analgesic drops.

Among parents in the wait group who filled the prescription, 60 per cent said they did so because of fever, 34 per cent for earache and six per cent for fussy behaviour.

No serious side-effects were reported.

Advantages of waiting

The waiting approach "may interrupt the cycle of antibiotic prescription, the expectation of parents to immediately treat [ear infections] with an antibiotic and subsequent medical visits for this illness," the researchers wrote.

Routine use of the waiting approach for ear infections "will reduce both the costs and adverse effects associated with antibiotic treatment and should reduce selective pressure for organisms resistant to commonly used antimicrobials."

In a commentary on the study, Dr. Paul Little of the University of Southampton, U.K., suggested doctors use the delayed prescription approach unless the child is seriously ill or has other systemic health problems.

"If parents are given clear information about the timing of antibiotic use, and specific guidelines for signs and symptoms that should trigger reassessment, delayed prescribing probably has its place, should be acceptable
to parents, appears reasonably safe and provides a significant step in the battle against antibiotic resistance," Little said.

Little reported receiving a consultant's fee from a drug company for sessions on the complications of respiratory infections.