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Do you have kids or know someone who
has kids that constantly have ear infections? Ear infections
account for over 15 million visits per year to the doctor with
over 80% resulting in an antibiotic prescription. The big question
here is do all ear infections require antibiotics? This is a
complicated question that depends on diagnosis criteria, child’s
age, and severity of illness. All this combined will help your
doctor make an educated decision. This article is for parents to
become a little more knowledgeable about ear infections so they
can have a meaningful discussion with the doctor on why or why not
antibiotics are used.
In many European countries, the initial treatment for an ear
infection is symptomatic relief. If no improvement, antibiotics
are added. The American Academy of Pediatrics has set guidelines
for the treatment of otitis media (doctor word for ear infection!)
since May 2004.
First step, the doctor must determine whether or not an ear
infection exists. This is based on three criterias-sudden onset of
fever and earache, visualization by the doctor of fluid behind the
eardrum and inflammation of the eardrum. Remember, we are talking
about middle ear infections only, not swimmer’s ear.
Second step, your doctor has to determine whether antibiotics
should be given or not.
Children less than 6 months old, antibiotics will be started
whether the diagnosis is certain or uncertain. This is due to high
risk of complications in this age group.
Children 6 months to 2 years old, antibiotic treatment is
determined by the certainty of the diagnosis. When the doctor is
certain about the diagnosis (fluid and inflammation is seen),
antibiotics are started. When the doctor is uncertain and symptoms
are severe, antibiotics are started. When the diagnosis is not
certain and the symptoms are not severe, observation is chosen.
Children above 2 years old, antibiotic treatment is started only
if diagnosis is certain and symptoms are severe. If diagnosis is
certain and symptoms mild, or if diagnosis is uncertain,
observation is chosen.
What is observation? The most important part of this period is
pain control. Traditional pain relief is from acetaminophen or
ibuprofen. Your doctor may prescribe topical numbing agent. There
are home remedies such as oil, applying heat or cold to the
external ear, or naturopathic remedies, all of which have not been
studied for its efficacy or safety. This observation period is
reserved for otherwise healthy children above the age of 6 months
with no severe illness. Observation should only be used if an easy
line of communication with the doctor exists, if follow up is
available, and patient has access to medication if needed. If the
child does not improve or worsens in 48-72 hours, he/she needs to
be re-evaluated and started on antibiotics.
Third step, the doctor needs to decide which antibiotics.
Amoxicillin is still the first preference, even with all the new
and strong antibiotics around. If a child is started on the
stronger drugs when not needed, it can cause drug resistant
bacteria in the future. Even though these newer drugs are only
once a day and strong, be careful of its use when not needed. Your
doctor may choose another antibiotic if there is a penicillin
allergy or the child has been on antibiotics in the past 30 days.
At that point, your doctor will discuss the pros and cons of
various antibiotics.
Can we do anything to prevent the millions of office visits and
dollars wasted on ear infections? There are risk factors that are
unavoidable-genetics and family history, prematurity, multiple
siblings, Native American ethnicity. However, there are avoidable
risk factors also: tobacco smoke exposure, pacifier use after 6
months of age, bottle propping, which increases the number of
upper respiratory infection. There are a few factors that help
decrease the risks-breastfeeding at least 6 months, administration
of the yearly flu shot, and administration of the routine
pneumococcal vaccine series.
In conclusion, most colds, coughs, sore throats, runny nose, and
many ear infections are due to viruses. Antibiotics do not cure
viruses and may actually cause harm due to side effects or future
resistance not only in the child but also in our community.
If you have any further questions, please call (727) 526-PEDS
(7337) or email dr.bhumi@northeastkids.com. Please only
non-emergent questions on email.
Dr. Bhumi Upadhyay, a Board Certified Pediatrician and active
member of the American Academy of Pediatrics, graduated from the
University of Miami six year Honors Program in Medicine. She
completed her residency at The Childrens Hospital of Michigan and
has been practicing in the Tampa bay area for five years.
Northeast Pediatrics is a new solo pediatric practice, which
opened on November 1st 2005. Our mission is to provide personal
pediatric care to families of our community. Call 526-PEDS to
inquire about availability of the flu vaccine.
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