June 6, 2005—Ear infections are a common complaint of young children, and most have had at least one by the time they are three years old. Parents generally act quickly on ear pain, taking their child to the pediatrician for an antibiotic prescription. However, new research suggests that forgoing the antibiotic and simply monitoring your child's condition may be a useful strategy.
The latest evidence comes from study published today in Pediatrics, which showed that about two-thirds of childhood ear infections resolved without the use of antibiotics.
Since 60 percent of all antibiotics are prescribed for U.S. children with ear infections, "watchful waiting" may prevent the overuse of antibiotics and the subsequent rise in antibiotic-resistant bacteria, said David McCormick, MD, professor of pediatrics at the University of Texas and lead author of the study.
Learning what is going on inside your child's ear is important for understanding why skipping the antibiotics may keep your child healthier.
Ear Infections Exposed
An ear infection most often occurs when a child has a cold, throat infection or allergy. These conditions may cause the Eustachian tube, a canal that drains fluid from the middle ear to the back of the throat, to become clogged. With the tube blocked, fluid builds up in the middle ear. This fluid may become infected by bacteria or a virus, causing pain and swelling of the eardrum.
The younger a child, the more susceptible he or she is to an ear infection. An infant's Eustachian tube is shorter and more horizontal than an adult's, allowing bacteria to easily become trapped inside. Making matters worse, children in day care or school are frequently exposed to bacteria and viruses and have not yet built up any immunity to these bugs. Other risk factors include exposure to secondhand smoke and being bottle-fed on one's back, which increases the amount of trapped fluid in the ear, as opposed to being breast-fed.
A child with an ear infection sometimes has a hard time communicating the pain. While an older child can tell you his ear hurts, infants and toddlers will simply cry uncontrollably. The crying may get worse during feeding or when using a pacifier, as the sucking pulls on the eardrum. Some ear infections are associated with fever, difficulty hearing or a draining of yellowish fluid from your child's ear. If you notice these symptoms, make sure to see a pediatrician.
Health
Antibiotics vs. Waiting
The pediatrician will examine the inside of your child's ear. If he notices only mild redness and fluid, antibiotics are probably not necessary.
In this study, scientists looked at ear infections in 223 children ranging in age from 6 months to 12 years. The children were randomly assigned to either be treated with standard antibiotics or simply wait under the care of their parent or guardian. While the parents knew if their children were receiving antibiotics, the study scientists did not. Ultimately, 66 percent of children with a mild ear infection recovered without antibiotics. Those given antibiotics did recover faster than their patient counterparts, but were more likely to have drug-resistant bacteria in their nose during a later examination.
Antibiotics are probably necessary if the pain is severe, if the infection doesn't subside with watchful waiting or if a fever develops. If your child's condition does not improve after three days following the administration of an antibiotic, call your doctor. The infection may need to be treated with a different medication.
No matter what, be sure to finish any course of antibiotics that your doctor prescribes. Stopping an antibiotic early, even if your child is feeling totally better, will allow bacteria to regrow, potentially causing an infection that is resistant to the original antibiotic.
Soothing the Pain
Whether your child is taking an antibiotic or is waiting out the infection, your doctor will probably recommend a child's dose of nonaspirin acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to reduce pain. There are also numbing eardrops, called Auralgan, available by prescription. Chewing gum or placing a warm compress on the ear may help soothe discomfort in older children. Your doctor will also schedule a follow-up appointment a few weeks later to ensure that the infection has completely cleared.
Infinite Infections
Unfortunately, some children get repeated ear infections. Any time your child has more than four in a year, you should speak with your doctor about preventative treatment, such as a low-dose antibiotic or surgically inserting tubes to help the ears drain.
All children will develop an ear infection at some point, and antibiotics will almost always prove to be a successful treatment option. However, if your child has a mild ear infection, you may want to discuss the possibility of holding off on antibiotics and allowing your child's body to fight off the infection. This decision may prevent the development of antibiotic-resistant bacteria and, even worse, future infections that are resistant to antibiotics.
