RGH study looks at why ear infection rates are dropping

Aug 7, 2017

A new study in Pediatrics, led by a Rochester General Hospital physician, explores reasons why ear infections rates have been dropping. 

To learn more about ear infection rates, researchers with the Rochester General Hospital Research Institute spent 10 years following 615 children in the Rochester area. They gathered ear fluid, ran tests, and tried treatments that stray from the American Academy of Pediatrics guidelines.

“By testing for the germs we were able to discover that the regular antibiotic wasn’t going to work well enough in half the kids. So we switched. We would treat the kids with a stronger antibiotic. That way more of the kids would be cured,” said Dr. Michael Pichichero, senior author of the study.

Ear infections are the number one reason children get prescribed antibiotics. Pichichero found that using one stronger than Amoxicillin means fewer infections and fewer prescriptions for some children.

“Every time we give antibiotics it causes antibiotic resistance to potentially increase. So making better diagnoses helps to reduce antibiotics. And in Rochester, by using the perfect antibiotic for the individual child and by using the ear tap we reduce how often the antibiotics need to be used,” said Pichichero, who is also the director of the Rochester General Hospital Research Institute.

Doctors also performed a minor procedure called an ear tap for children in the study, which Pichichero says contributes to fewer infections.

“The doctor actually drains the pus from behind the ear, to relieve the pain and remove the infection fluid. Sort of like draining a pimple,” Pichichero said.

The study concludes there are two main reasons why ear infections have dropped over the past 30 years. For one, the American Academy of Pediatrics redefined criteria for what constitutes an ear infection, which Pichichero says means better diagnosis. And two, there has been an increased use of the pneumococcal vaccines, commonly referred to as the “pneumonia vaccine.”

Two physicians who were not involved with the study, Dr. Richard Wasserman with the University of Vermont’s Children Hospital and Dr. Jeffrey Garber with Children's Hospital of Pennsylvania, wrote a review that was also published in Pediatrics.

Wasserman and Garber noted that there is a “lack of clarity” regarding the study design and that some of the findings are not generalizable to a larger population since the treatments used in the study -- ear tap, alternate antibiotics and duration of antibiotic therapy -- stray from the most recent American Academy of Pediatrics guidelines.

They recommended continued use of the pneumococcal vaccine but note that the best choice of antibiotic “remains unclear,” and call for more clinical trials.