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Otitis Media: Probiotics Should be Given Alongside Antibiotics

We are in the full swing of cold and flu season. I’m hopeful everyone got their flu shot and is staying healthy. However, if you’re not so fortunate and your kids are suffering with symptoms, then this is a very timely newsletter for you to read.

This month we will explore two important clinical studies published in the January 13th issue of the New England Journal of Medicine (1,2).  These studies provide evidence that prescribing antibiotics is beneficial for infants and young children who are suffering with a very common disorder called otitis media.  This is an infection of the middle ear, usually due to bacteria.

For a number of years, the pediatric medical organizations recommended watchful waiting for some children with evidence of acute otitis media. This is primarily because some children with mild infections may improve without the use of antibiotics. Unfortunately, the problem is the identification of which children will do well without antibiotics.

While many physicians do not like to prescribe antibiotics, and often only do so if no other solutions are available, otitis media can become a very serious condition. In some children it can progress to the point of a perforation of the eardrum or even lead to the development of mastoiditis. Clearly, waiting to treat a child can be a risk.

To determine the efficacy of antibiotics on acute otitis media, the researchers in these recent studies prescribed a very effective antibiotic to one group of children and the other group received a placebo. The children were followed closely for 7-10 days to determine the treatment outcome.  If the children receiving the placebo developed worsening infections, they would be given “rescue therapy.”

The results were of the treatment were as follows:

  • Children on antibiotics: 18.6% treatment failure
  • Childen on placebo: 44.9% treatment failure

The authors concluded that otitis media in this age group is a treatable disease with the use of antibiotics: “More young children with a certain diagnosis of acute otits media recover more quickly when they are treated with an appropriate antimicrobial agent.” (2)

The next step in these research studies is to determine how to identify the children who may get better without the use of antibiotics.

Unwanted Side Effects of Antibiotics

It’s worth noting that two of the most frequent adverse events occurring in the children receiving antibiotics were diarrhea and diaper area dermatitis. More than 50% of the children in the antibiotic group developed diarrhea and/or diaper rash. Among the children who received a placebo, only 25% experienced these side effects.

So how can these effects be mitigated if your child needs to take an antibiotic? There are several published studies (3) that have found that taking a probiotic when antibiotics are prescribed can reduce the risk of developing diarrhea by roughly 50%.  While very few medications or treatments are 100% effective, taking a probiotic for a 50% chance to reduce the risk of antibiotic related diarrhea and diaper rash is a worthwhile effort.

Take Home Message

If your child is prescribed an antibiotic, consider adding a probiotic that will lessen the risk of diarrhea and diaper rash. Remember to separate the timing of the antibiotic and probiotic by two hours to insure the probiotic bacteria are not destroyed by the antibiotic.

Finally, to be successful, the probiotic serving size should be greater than 10 billion bacteria and consist of multistrain, multispecies organisms like those in EndoMune Jr.

Wishing you and your children a very healthy winter season!

Eat healthy, exercise and live well!
Dr. Hoberman


(1) A placebo-controlled trial of antimicrobial treatment for acute otitis media. Tähtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. N Engl J Med. 2011 Jan 13;364(2):116-26.

(2) Treatment of acute otitis media in children under 2 years of age. Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn DK, Kurs-Lasky M, Bhatnagar S, Haralam MA, Zoffel LM, Jenkins C, Pope MA, Balentine TL, Barbadora KA.N Engl J Med. 2011 Jan 13;364(2):105-15.

(3) Probiotics for prevention of antibiotic-associated diarrhea. Doron SIHibberd PLGorbach SLJ Clin Gastroenterol. 2008 Jul;42 Suppl 2:S58-63.

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