Antibiotics And Ear Infections
What's the big deal about antibiotics?
It's the crux
of the matter.
What happens if we don't use Antibiotics for an Ear Infection?
Longer duration of illness? Increased risk of complications?
Do antibiotics help the kids at greatest risk?
The kids at greatest risk are those in day care,
who are bottle feeding, have a family history of frequent ear infections, who
use a pacifier and those who have parents who smoke. We know that these are the
children at highest risk for complications of ear infections, but we have no
real evidence that says that antibiotics help those kids prevent the
complications. What is clear is that we should have day care providers ( and all
of us really) wash our hands frequently to prevent the spread of infectious
disease. We need to increase the rate of breastfeeding in this country and we
need to have families create smoke free environments.
How about the length of treatment?
Recent studies indicate that the level of
antibiotics in the area that we want them to go (the middle ear) drops off
significantly after 2 days or so. That means that the 10 days for which we are
traditionally treating the infection may be unnecessary, and that a course of 3,
5 or 7 days might be fine.
So when should we treat?
Your child should look sick before we treat them. The presence of fever and or ear pain doesn't really help, believe it or not. What I'm in favor of is waiting, treating symptoms in the meantime, and seeing what happens: "masterful inactivity." If the symptoms persist, we treat. What I have been doing is sending you home with the prescription and asking you to wait to fill it. If your child is still symptomatic after 48 hours, then fill the prescription. We'll have closer follow up with kids who are less than 2 and we'll need to check kids under 2 (this is the age group that can't tell me that they have pain or aren't hearing well) for persistence of fluid after the acute infections. That's what we do at the one month follow up. All ear infections leave a bit of fluid behind as they heal. That fluid does not have bacteria in it usually, so careful observation is all that's needed. Presence of that fluid for more than 3 months is the thing correlated with hearing loss and need for tubes, and if it's there after 3 months, I send you to a fine ENT doctor for evaluation for tubes.