Abstract 910

We surveyed use of homeopathic medicines for acute otitis media (AOM) in 2 practices in order to learn what medicines are used for AOM, how medicines are chosen for a particular child, and to assess challenges to be faced when planning randomized trials comparing antibiotics and homeopathic medicines for AOM.

Children with AOM (presence of middle ear fluid plus a sign of acute illness) were enrolled from 2 practices where homeopathy is the main treatment modality. One homepathic medicine was prescribed for each child at the time of diagnosis. Parents were telephoned at days 1,2 and 3 after diagnosis, and children were seen in the office at days 14 and 28, and at other times if ill.

Twenty-four children (8 months-77 months) were enrolled during 1997-98. All parents had attended college; 70% were college graduates. 95% of infants were breastfed (mean duration 14.8 months); 63% attended day care; 58% had prior ear infections. Average length of the enrollment visit was 30 minutes. Ten homeopathic medications were prescribed at the initial visit: Pulsatilla for 11/25 (46%) of children, Psorinum (13%), Calcarea sulphurica (8%), Arsenicum (8%), and Calcaria carbonica, Mercurius, Lac humanum, Chamomilla, Kali carbonica, and Hepar in one child each. Five children received new medicines and 2 children received additional doses of the same medicine at unscheduled visits before day 14. On day 14, 6 children received additional doses of the original medicine, and 5 children received new medicines. On day 28, 2 children received new medicines, and 6 were prescribed additional doses of medicines prescribed at other times during the study period. Two children received antibacterial agents and were the only patients regarded as treatment failures by the homeopaths.

Randomized trials of homeopathy will be valuable as families are choosing this modality of therapy in increasing numbers. Based on this survey, the following challenges in planning randomized trials assessing efficacy of homeopathy for AOM were identified: families who select homeopathy differ demographically from families using allopathic medicine; homeopathic medicines are numerous and varied; selection of medicines are based on patient rather than disease characteristics making randomization methodologically difficult; there are a limited number of experienced homeopathic pediatricians and family practitioners, and outcome measures, including failure of therapy, may be difficult to define, though such definitions will be critical to study design.