Antibiotics and Ear Infections: Should Children Take Them?

Every parent has been there. One minute your child is well and the next they are tugging their ears crying because of an earache. Your first reaction is to immediately rush them to the doctor in hopes of receiving a very good prescription for antibiotics. Why not? Aren't antibiotics a better choice for faster relief? Besides they would cure the body of all ailments and infections better than some over-the-counter medications, right?

Wrong! New studies have shown that administering antibiotics immediately to children at the onset of an ear infection is no longer recommended. The preferred method of treating ear infections in children is to follow the wait-and-see approach before administering any form of antibiotic.

In 2004 the American Academy of Pediatrics released a clinical practice guideline on the diagnosis and management of ear infections. Apparently there has been a growing concern over the frequency of antibacterial prescriptions and the increasing resistance among many of the pathogens that has resulted from frequent antibiotic use.

What is an ear infection?

An ear infection is an inflammation, or infection, of the middle ear. Most ear infections are caused by bacteria, but viruses can lead to an ear infection. The respiratory syncytial virus (RSV) is a leading cause of ear infections, followed by influenza (flu) viruses. It often happens during a cold, or some other form of illness. This is why prescribing antibiotics for treatment doesn't always work because they can kill bacteria and not viruses.

Ear infections often occur in infants and young children. Often when children are sick they normally have an ear infection. Roughly three out of four children will experience an ear infection before they turn 7 years old. Children often have a harder time fighting an illness than adults. As a result, they develop ear infections more often. It is believed that children can also develop an ear infection as a result of hanging around cigarette smoke.

Different types of otitis media

There are two different kinds of otitis media. Acute Otitis Media (AOM) is where parts of the ear are infected and swollen. Fluid and mucus are lodged inside the ear causing much pain to the area. Otitis Media with effusion (fluid), or OME, is the second kind of ear infection. This is where fluid and mucus remains trapped in the ear after an infection has passed. OME makes it harder for the ear to fight off any new infections. This can cause hearing problems for children.

Wait-and-See Approach

This approach gives parents the option of delaying the use of antibiotics for the treatment of an ear infection in children. Ever since parents have been given the option to delay the use of antibiotics, there has been little difference in the outcomes when compared to children who have received an antibiotic to treat ear infections. It has been found that most ear infections heal on their own without the use of antibiotics within a matter of days. In fact, it has been found that roughly 80 percent of children with ear infections recover without antibiotics.

This new guideline, however, does have restrictions on the age limit for children.

"The guideline only applies to kids who are two and older," says Dr. Ann Mortensen, a physician at DMC Children's Hospital of Michigan in Detroit. "You can only observe them if their illness is not severe. If there isn't any fever or signs of severe pain then they are okay to observe from 48 to 72 hours."

Physicians in the United States normally prescribe antibiotics in children who are younger than two. Children under the age of two are at a higher risk of developing complications resulting from an ear infection. Children can experience hearing loss, which is rare. If hearing loss does occur, it is normally mild to moderate, but temporary. A rupture in the eardrum can also take place. This normally happens as a result of repeat fluid build up in the middle ear. A small hole is normally left that will heal in two weeks time.

Children over the age of two are monitored closely by a physician for a few days to see how the ear infection is healing. If the infection is not healing an antibiotic is prescribed. It is important to stress that antibiotics are also given immediately to children with chronic medical conditions like cystic fibrosis, or heart disease; who are severely dehydrated; suffering from a terribly high fever; seriously ill; or are in severe pain.

What to prescribe for pain

What can a parent do for pain while they are waiting for the ear infection to pass? For one, parents can give their children medicine that can be found over-the-counter at the nearest drug store.

"The best thing for pain in children includes medication like Tylenol. Parents can also give their children other medication such as Ibuprofin, Children's Advil and Children's Motrin. If needed, a physician can also prescribe ear drops to help ease ear pain that is local," says Dr. Mortensen.

If an antibiotic is needed, normally amoxicillin (Amoxil) is prescribed because it has a reputation for working well and it is the most affordable brand on the market. However, if antibiotics are prescribed too frequently, the possibility of developing antibiotic-resistant bacteria can often occur.

"The problem with resistance and why we try not to use antibiotics unless they are truly indicated is that when bacteria grow resistant to antibiotics, there are fewer antibiotics available to treat them. If there is a case where you have grown seriously ill from a bacteria, there may not be a supply of antibiotics strong enough to treat them," Dr. Mortensen explained.

How to tell if your child has an ear infection

It is often difficult to tell if your child has an ear infection or not. Normally infants are unable to say that their ears are hurting unless they are tugging away. Older children are able to voice that there is pain in their ears. Either way, it is imperative that every parent watch their child closely and look for any signs or symptoms indicating that an infection has taken place.

Here are a few ways to tell if your child has an infection in their ears:

• tugging at the ears
• crying more often than usual
• drainage in the ears
• trouble sleeping
• difficulty maintaining their balance
• difficulty sleeping
• no response to quiet sounds
• the presence of a fever

If any of these signs are present, contact their physician immediately. In the end, the best way to tell if your child has an ear infection is with a vist to the doctor's office.

Citations

Medline Plus, National Institutes of Health. Ear Infections: Facts for Parents about Otitis Media. Retrieved March 16, 2007, from National Institutes of Health Web site: http://www.nlm.nih.gov/medlineplus/earinfections.html

Familydoctory.org, Family Academy of Family Physicians. Antibiotics: When They Can and Can't Help. Retrieved February 6, 2007, from Familydoctor.org Web site http://www.familydoctor.org/680.xml?printxml

WebMD.com. Medications. Retrieved January 10, 2007, from http://www.webmd.com/hw/ear_disorders/aa60567.asp?printing=true

MayoClinic.com. Ear Infection, middle ear. Retrieved February 4, 2007, from http://www.mayoclinic.com/print/ear-infections/DS00303/DSECTION=8&METHOD=print

Aurora Health Care. Get smart about antibiotics. Retrieved February 6, 2007, from http://aurorahealthcare.org/services/free55/news/2003/spring/antibiotics.asp

MayoClinc.com. Superbugs: How antibiotic resistance develops. Retrieved February 6, 2007, from http://www.mayoclinic.com/print/antibiotics/FL00075/METHOD=print

Subcommittee on Management of Acute Otitis Media. (2004). Diagnosis and Management of Acute Otitis Media. Pediatrics, 113, 1451-1462.