Acute Otitis Media is the most
common upper respiratory condition
treated in pediatric offices and the
treatment of this condition continues
to be the most controversial in the
medical community (1-3).
The majority of children suffering from
Acute Otitis Media will automatically
be placed on antibiotics despite
growing evidence that suggests
there’s only a marginal benefit from
this form of care (4).
The pediatric community is being
confronted primarily by mounting
evidence that the standard use of
antibiotics may be an outdated practice
with little value and what appears
to be greater risk to the child.
When prescribing antibiotics for your
child your pediatrician should be willing
to answer the question, “Does this
case warrant a prescription”?
Let’s consider an observation
published recently by the American
Academy of Pediatrics and the
American Academy of Family
Physicians:
“Each course of antibiotics
given to a child can make future
infections more difficult to treat.
The result is an increase in the
use of a larger range of—and
generally more expensive—
antibiotics. In addition, the
benefit of antibiotics for Acute
Otitis Media is small on average
and must be balanced against
potential harm of therapy. About
15 percent of children who take
antibiotics suffer from diarrhea
or vomiting and up to 5 percent
have allergic reactions, which can
be serious or life threatening. The
average preschooler carries around
1 to 2 pounds of bacteria – about
5 percent of his or her body weight.
These bacteria have 3.5 billion
years of experience in resisting and
surviving environmental challenges.
Resistant bacteria in a child can
be passed to siblings, other family
members, neighbors, and peers
in group-care or school settings.” (5)
Scientific Evidence
Scientific evidence puts forth the
following information:
• Children with high temperature
or vomiting improved after an
average of three days.
• Children with high temperature
or vomiting were likely to benefit
from antibiotics, although it’s still
reasonable to wait 24 to 48 hours
since many children will improve
when left to their body’s own
natural defenses.
• Children without high temperature
or vomiting were not expected to
benefit from immediate antibiotics.
Considering this information it’s best
to take an option to observe stance
since 80 percent of children with
Acute Otitis Media get better without
antibiotics within 48 to 72 hours (6).
With this scientific evidence mounting,
ask yourself a few questions:
Will my pediatrician continue to
prescribe antibiotics to my child
based on his or her old programming
and habits despite growing
evidence that suggests antibiotics
make little difference?
Does my pediatrician continue to
have concerns that there’s a risk
for dangerous complications, such
as Acute Mastoiditis, despite the
fact that it’s documented as a
“rare occurrence” (2)?
As a parent, what do
you need to know?
• That there is mounting evidence
from the research community that
the use of antibiotics has very
little effect on Acute Otitis Media;
• That your doctor may be prescribing
antibiotics based on old habits
or the concern of developing acute
mastoiditis, which has proven to
be rare;
• That when delaying the use of
antibiotics for 72 hours, even if
your child is suffering from fever
and vomiting, 50 percent of all
Antibiotics and the
pathways 3
children improve within that time
period;
• That children with Acute Otitis
Media but without fever and
vomiting receive very little benefit
from the use of antibiotics (this
child should not begin antibiotics
unless their condition worsens);
• It’s your child and you can take
the initiative by asking your
pediatrician to consider waiting
72 hours before introducing the
antibiotic.
Prevention is the Key
New guidelines set forth by the
American Academy of Pediatrics
and the American Academy of Family
Physicians recommend that the clinician
take an active role in preventing
Acute Otitis Media. A few suggestions
included:
• Altering child care
center attendance
• Breastfeeding for
the first 6 months
• Avoid supine bottle-feeding
(bottle propping)
• Reduce or eliminate pacifier
in the second six months of life
• Eliminate exposure
to passive smoke
A Healthy Alternative
Take the common sense approach
to otitis media and consider chiropractic
care. The Fallon study with
332 participating children suggests
that chiropractic care may be more
effective than drug therapy (7).
Be aware that your chiropractor
is not opposed to antibiotics when
necessary, but the chiropractic
profession acknowledges that over
usage is prevalent in our country
and that the habits of medical
doctors may not have caught up
with the latest research.
A Final Thought
For the overall wellness of your child,
participate in all decisions when it
comes to the usage of antibiotics
and seek other non-invasive forms
of care. Remember, it’s your child
and you have a say in his or her care.
Most importantly, initiate healthy
lifestyle choices for your family and
include regular chiropractic care as
part of your family’s achievement
towards wellness.
Dr. Claudia Anrig is a Board Member of
the International Chiropractic Pediatric
Association. She has dedicated her
chiropractic career to the specialty
of pregnancy and pediatrics. Dr. Anrig
has co-authored “Chiropractic
Pediatrics” a comprehensive text
book on the clinical care for pregnant
women and children. Along with her
successful practice in Fresno, CA,
since 1982, Dr. Anrig has lectured
internationally to colleagues on the
importance of chiropractic care in
pregnancy and for children.
1. Bain J. Childhood otalgia: Acute Otitis Media.
2. Justification for antibiotic use in general
practice. BMJ 1990;300: 1006-1007.
2. Browning G. Childhood otalgia: Acute Otitis
Media. 1. Antibiotics not necessary in most
cases. BMJ 1990; 300: 1005-1006.
