"What it boils down to is that a lot of uncertainty in prior investigations was because the diagnosis was not always as secure as these two papers, where they've really been very careful," said Klein, who wrote an editorial supporting the results of both studies, reported in the Jan. 13 issue of the New England Journal of Medicine.
"A more casual approach to treatment muddied the waters" over antibiotic use in prior studies, Klein added, noting that he didn't expect the debate to die despite the latest findings.
In the Pittsburgh study, 291 children between the ages of 6 months and 23 months old with certain ear infections -- as defined by the presence of a bulging eardrum and parental observations, among other symptoms -- were split into groups receiving antibiotics or placebos for 10 days.
Among those who received amoxicillin-clavulanate, 35 percent had initial resolution of symptoms by day two; 61 percent by day four; and 80 percent by day seven. In contrast, of those on placebo, 28 percent had initial resolution of symptoms by day two, 54 percent by day four and 74 percent by day seven.
But the rate of clinical failure for those on antibiotics after day four or five was only 4 percent, vs. 23 percent for those on placebo, the study found.
The Finnish research looked at 319 children between the ages of 6 months and 35 months for seven days, finding that treatment failure occurred by the end of the study period in 18.6 percent of children who received amoxicillin, compared to 44.9 percent of those on placebo.
More research is needed to help doctors identify the children who will benefit most from treatment, the authors said. Such studies could reduce unnecessary use of antibiotics and the potential for antibiotic resistance, they said.
"I thought [the Pittsburgh research] was a very good study," said Dr. Tumaini Coker, an assistant professor of pediatrics at t
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