More children are treated in the U.S. with antibiotics for inflammation of the middle ear, or otitis media, than any other child health problem. More than five million cases are diagnosed every year. But now, a scholarly review of more than 100 studies by a University of Virginia pediatrician has concluded that antibiotics help just one in eight children with ear infections.

Dr. J. Owen Hendley, professor of pediatrics and a specialist in pediatric infectious diseases, wrote, in a recent edition of the New England Journal of Medicine, that placebo-controlled trials found ear infections had gone away in one week in 81% of placebo recipients, as compared with 94% of antibiotic recipients.

Hendley said there is a clear downside to the use of antibiotics to treat common ear infections.

"The bacteria which cause ear infections learn quickly to be resistant to antibiotics. At some point we're going to run out of drugs to treat the problem," he noted. "Antibiotic resistance is a huge problem in this country. The practice of treating eight children to help the one who needs antibiotics just makes it worse."

When they diagnose an ear infection, M.D.s should hold off giving antibiotics for 48 to 72 hours, Hendley advised, because the infection can clear up spontaneously. The pain and irritability that accompany ear infections should be treated with children's acetaminophen, ibuprofen or other pain relievers.

However, Hendley found that an antibiotic, such as amoxicillin, is recommended for a less common ear infection, bacterial otitis media or "pus drum," characterized by bulging eardrums and visible pus.

Hendley's review also shed light on the increasing use of tympanotomy tubes in the eardrum to help drain fluid from the middle ear in children with recurrent ear infections, usually three or four episodes within six months. He said there is no benefit to children unless they suffer from more severe bacterial otitis. Often, the fluid goes away on its own, he pointed out.

The review also found that giving children a flu shot can reduce the likelihood of otitis by 30%, but the benefit only lasts during flu season, about six weeks out of the year.