Volume 16 • Issue 46 | April 9 - 15, 2004

No more pink potion for ear infections

By Dr. Michel Cohen

Children’s ear infections no longer automatically need to be treated with antibiotics, according to a recent statement by the American Academy of Pediatrics and Family Physicians. Well it’s about time!

It has taken way too long for these respectable authorities to consider the results of the serious research done in Europe which demonstrates that systematically treating ear infections with antibiotics is not the best option.

In Holland, ear infections have not been routinely treated with antibiotics since the early nineties with no evidence of a worse outcome.

Ear infections primarily afflict toddlers, with the frequency of infection tapering off as kids get older. They often follow a cold or flu, because such ailments create a germ-friendly environment. Ear infections are not contagious, although the associated cold that can trigger them is.

Discomfort stems from the buildup of pressure in the middle ear. The degree of pain varies: Some ear infections may go unnoticed, while others can be excruciating. The pain peaks in the first twenty-four hours, and rarely lasts for more than a couple of days. A sensation of fullness or ringing in the ear may linger for up to a week after the infection has gone.

Fevers typically accompany ear infections, and infants especially may suffer quite high temperatures. Vomiting, diarrhea, and poor appetite can also occur in varying degrees of intensity.

The most common complication of an ear infection is temporary hearing loss. Following an episode, you will probably hear your kid say “what?” even more than usual, until the fluid remaining in his middle ear drains and a full range of hearing is recovered, which may take a couple of months.

In extremely rare cases, serious complications can arise when the infection spreads to the surrounding bone or the brain. For the longest time doctors believed antibiotics were the only way of alleviating symptoms and preventing complications from ear infections. For that reason, almost every kid has ingested large amounts of a yummy pink bubble-gum-flavored antibiotic. But this common and widespread use of antibiotics has resulted in a serious problem: antibiotic resistance.

The reality is that most ear infections, whether caused by a virus or a bacterium, will heal without any antibiotics and without any complications.

Increasingly, the standard of care for children with an ear infection will be to soothe their pain with acetaminophen or ibuprofen and observe them carefully for signs of a persisting infection.

Pain medications are magical in their immediacy: your kid will go from crying to singing as soon as they take effect.

If the infection does not subside on its own within a couple of days, as indicated by persistent fever and pain, then an oral antibiotic prescribed by your doctor is warranted. When the treatment is instituted at this stage, the ear infection clears up rapidly. It’s worth noting, however, that it’s hard to know if you’re seeing a delayed effect of the body’s own immune system or the antibiotic at work. Even when the infection doesn’t clear up, waiting and watching for a couple of days allows the body’s natural defenses time to take effect and strengthen the response.

In my practice, I have implemented this conservative approach and seen the benefits of not systematically jumping to antibiotics. I still get some wide-eyed looks from parents when I explain that the best treatment for their kids misery is simply pain relief, but I have found that most of them are very happy to forgo an unnecessary course of antibiotics.

To my point of view, the laissez-faire approach - treating only those few ear infections that do not resolve instead of all of them - is far more logical. It spares children the potential side effects of medications and helps keep their resistance to antibiotics low.

Unfortunately, despite the scientific evidence, and this new recommendation, many doctors are still heavy-handed with the prescription pad when it comes to ear infections, probably because of a fear of liability, the ingrained habit of dispensing gallons of pink medication, and their own aversion to feeling useless.

Dr. Michel Cohen is a Tribeca pediatrician and author of “The New Basics: A-to-Z Baby and Child Care Guide for the Modern Parent.” Dr. Cohen can be reached via e-mail at his website: www.thenewbasics.com.


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