Changing Patterns in the Treatment of Childhood Ear Infections
Childhood ear infections are very common. Almost every child will have an ear infection at one time in their life, with the first few years of life being the most common. Ear infections (acute otitis media) are usually caused by bacteria and will respond to antibiotics.
Unfortunately with the increased use of antibiotics, some bacteria have developed resistance and will not respond to normally prescribed antibiotics. In the past few years several medical societies and the Center of Disease Control (www.CDC.gov) have tried to educate parents about preventing ear infections and health care providers on the treatment of ear infections.
There are several reasons why some children have more ear infections. A family history of ear problems and prematurity places your child at greater risk for infections. Breast feeding has been shown to reduce the risk of otitis media. Pacifiers, second hand smoke, and daycare also increase the risk. The Prevnar vaccine can reduce your child’s risk of ear infections.
Knowing when a young child has an ear infection can be very difficult. The only reliable symptom is ear pain, but not many one year olds can tell you this. Rubbing or pulling of the ears, poor sleep patterns, vomiting, or poor appetite are not reliable indicators of an ear infection.
It can also be difficult for your health care provider to know if your child has an ear infection. Examination of the ear drum will tell if your child has fluid behind the ear drum (middle ear effusion), but the presence of fluid does not mean that your child needs an antibiotic. Most children with fluid will resolve without treatment.
The new guidelines take into account the age of the child and other symptoms or signs of illness. Most infants (under the age of 6 months) will be treated with antibiotics if there is any suspicion of an ear infection. In toddlers (under the age of 2) your health care provider will look for other suggestive signs of an ear infection such as a high fever or a runny nose. For children over the age of 2 in the absence of ear pain or severe symptoms, your provider may elect to observe your child, usually with a follow up in a few days.
If your child should go on antibiotics, amoxicillin is still the most commonly recommended antibiotic for otitis media. In children who are allergic to penicillin, azithromycin (Z Pack) or a sulfa based antibiotic (i.e. Pediazole) may be used. In children who fail treatment, either Augmentin, clindamycin, or an injection of ceftriaxone (Rocephin) may be necessary.
Most children will eventually out grow ear infections without major problems; however, some children with difficult to treat ear infections, developmental problems, or anatomic deformities may need to have ventilation tubes surgically placed. Your pediatrician or other health care provider can help you navigate through the variety of options for your child.