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Antibiotics for Middle Ear Infections - Love 'Em or Leave 'Em
Antibiotics have only been in the medical arsenal for about 75 years, starting with sulfa drugs in the 1930s and penicillin in the 1940s. There are now dozens of different and more potent antibiotics, but very few new ones are patented. Since their discovery, antibiotics have saved umpteen millions of lives, and still do everyday. However, antibiotics have been heavily used and abused from their debut. Slowly but surely, they are become less and less effective.
As a child, our local, small town GP used to give injections of penicillin for just about any reason, it seemed. If you had a sore throat or tonsillitis, you got a shot of penicillin. If you had a fever for unknown reasons, you got a shot of penicillin. If you were uncooperative in his office, fearing that you will get a shot of penicillin, you got a shot of penicillin. He was such a shot-doctor, that kids would not even go to his door for Halloween.
In the U.S. as in many other countries, antibiotics are controlled by medical prescriptions. However, in places like Mexico, you can simply walk into a pharmacy and buy them - assuming they are "real ones" and not fake, counterfeit substitutes. With a Canadian doctor's prescription, you can easily buy large quantities in Canada. It is not uncommon for Americans to smuggle antibiotics in huge amounts across the borders, primarily for personal use, or share among friends. Some people have literally become Amoxiholics!
Antibiotics are only used to treat susceptible bacterial infections. They are completely ineffective against viruses - the main cause of most diseases. If they are self-administered indiscriminately for viral illness, not only will they be ineffective, they can make things worse. Sub-therapeutic doses of antibiotics help create resistant strains - the dreaded Superbugs. Primitive microorganisms can rapidly adapt to most antibiotics, even when given appropriately. There are bacterial strains out there that are completely resistant to EVERY known antibiotic. You really don't want an infection from these guys.
One of the major reasons antibiotics are prescribed for children is for the treatment of otitis media - the middle ear infection. Surprisingly, the vast majority of middle ear infections in children will resolve spontaneously in a few days, WITHOUT antibiotics. So, why do clinicians keep giving them and parents keep demanding them? That is the billion dollar question. Controlled, scientific studies in the U.S. and Europe have proven time and again, that antibiotics are only needed for the treatment of otitis media in very young children with immature immune systems, immunocompromised children (children with diabetes, cancer, etc.), or in children that are very toxic-appearing. These are the children who are very ill, in extreme pain, and not fighting off their infections naturally.
In Europe, children with otitis media are not routinely treated with antibiotics for at least the first week. That does not mean they are not treated in other ways for these painful afflictions. Children are routinely given pain medications - usually more than just acetaminophen or ibuprofen - to make them more comfortable while Nature orchestrates the cure. In the U.S., the typical care involves the early use of antibiotics, even in cases where the child does not even have signs of middle ear infection, and mild pain medications.
Over 90% of European children get better, on their own, with just pain medications, and tend to have fewer recurrent middle ear infections and need for surgical tubes. The U.S. kids tend to get better, too, but with potent and expensive antibiotics on board that more and more clinicians feel are unnecessary. Old treatment habits are hard to break.
I had a posting on the Ear, Nose, and Throat message board recently by a person inquiring about the proper dose of amoxicillin for her two children. She felt that the doctor's dosage was way too high, and that she would prefer to give half-doses. I really wanted to tell her that antibiotics are not really needed at all in most cases; but of course I knew nothing about her children and cannot blindly tell her not to use them. I assume that her children were properly examined, and probably treated with the appropriate dosage of amoxicillin. For most clinicians, treating otitis media is really routine stuff. However, most clinicians have not jumped on the "no antibiotic" bandwagon.
When amoxicillin first came out, maybe twenty years ago, it was dirt-cheap - only a few dollars for a standard, ten-day course. Children were treated, based on body weight, at about 20-30 mg/kg per day, in three divided doses. Amoxicillin virtually replaced ampicillin - an antibiotic that had some nasty gastrointestinal side-effects (like explosive diarrhea) and had to be given four times per day, a dosage nightmare for busy parents. The bubble-gum flavored amoxicillin even tasted better. For nearly a decade this dosage seemed to work great. Later, studies started to show that amoxicillin can be given twice a day, even more convenient for busy parents, and for as little as five days instead of ten.
My wife and I used to teach an all-day pediatric class for child care providers. I remember putting my lunch in their refrigerator, only to be shocked by the dozens and dozens of bottles of amoxicillin, all lined up for the various kids.
As the years progressed, everyone started using amoxicillin (a lot), still the drug of choice for otitis media. Unfortunately, amoxicillin started to fail as resistant strains took over. Many clinicians would abandon using it after the first-failure, until studies showed that a higher dose was more effective. Now, the standard dosage for amoxicillin (in children) is 60-80 mg /kg - more than twice the original dosage.
There are now about two dozen different antibiotics that can be used for pediatric middle ear infections. Every day in my clinic, I encounter the otitis media frequent flyers, usually on their way to the surgery center for tubes. There is a better way, but it is going to take a partnership of parent and medical provider to change the way we treat these kids. We need to trust that our immune systems have protected us long before the advent of antibiotics, and will continue to do so, IF we give them a chance.
Parents can help by not insisting on antibiotics, especially when clearly told that the child does not have a middle ear infection at the moment. Sure, they may get one tomorrow or over the weekend, or while you are at Disneyland, but that never justifies giving antibiotics prematurely.
Medical providers need to stand their ground and resist antibiotic solicitation from worried parents. Instead of medication, a healthy dose of EDUCATION needs to be administered. Parents who have children with frequent ear infections need to have a home otoscope, and learn how to use it. Medical providers have an obligation to cooperate with these novice otoscope-users, and encourage, not discourage their use. Parents should choose a medical provider that allows for this type of participatory care.
I still feel that antibiotics are miracle drugs, but the real miracle is to know when and how to use them. The bugs are getting smarter, and we need to be smart, too - always staying one step ahead.
Related Topics:
As a child, our local, small town GP used to give injections of penicillin for just about any reason, it seemed. If you had a sore throat or tonsillitis, you got a shot of penicillin. If you had a fever for unknown reasons, you got a shot of penicillin. If you were uncooperative in his office, fearing that you will get a shot of penicillin, you got a shot of penicillin. He was such a shot-doctor, that kids would not even go to his door for Halloween.
In the U.S. as in many other countries, antibiotics are controlled by medical prescriptions. However, in places like Mexico, you can simply walk into a pharmacy and buy them - assuming they are "real ones" and not fake, counterfeit substitutes. With a Canadian doctor's prescription, you can easily buy large quantities in Canada. It is not uncommon for Americans to smuggle antibiotics in huge amounts across the borders, primarily for personal use, or share among friends. Some people have literally become Amoxiholics!
Antibiotics are only used to treat susceptible bacterial infections. They are completely ineffective against viruses - the main cause of most diseases. If they are self-administered indiscriminately for viral illness, not only will they be ineffective, they can make things worse. Sub-therapeutic doses of antibiotics help create resistant strains - the dreaded Superbugs. Primitive microorganisms can rapidly adapt to most antibiotics, even when given appropriately. There are bacterial strains out there that are completely resistant to EVERY known antibiotic. You really don't want an infection from these guys.
One of the major reasons antibiotics are prescribed for children is for the treatment of otitis media - the middle ear infection. Surprisingly, the vast majority of middle ear infections in children will resolve spontaneously in a few days, WITHOUT antibiotics. So, why do clinicians keep giving them and parents keep demanding them? That is the billion dollar question. Controlled, scientific studies in the U.S. and Europe have proven time and again, that antibiotics are only needed for the treatment of otitis media in very young children with immature immune systems, immunocompromised children (children with diabetes, cancer, etc.), or in children that are very toxic-appearing. These are the children who are very ill, in extreme pain, and not fighting off their infections naturally.
In Europe, children with otitis media are not routinely treated with antibiotics for at least the first week. That does not mean they are not treated in other ways for these painful afflictions. Children are routinely given pain medications - usually more than just acetaminophen or ibuprofen - to make them more comfortable while Nature orchestrates the cure. In the U.S., the typical care involves the early use of antibiotics, even in cases where the child does not even have signs of middle ear infection, and mild pain medications.
Over 90% of European children get better, on their own, with just pain medications, and tend to have fewer recurrent middle ear infections and need for surgical tubes. The U.S. kids tend to get better, too, but with potent and expensive antibiotics on board that more and more clinicians feel are unnecessary. Old treatment habits are hard to break.
I had a posting on the Ear, Nose, and Throat message board recently by a person inquiring about the proper dose of amoxicillin for her two children. She felt that the doctor's dosage was way too high, and that she would prefer to give half-doses. I really wanted to tell her that antibiotics are not really needed at all in most cases; but of course I knew nothing about her children and cannot blindly tell her not to use them. I assume that her children were properly examined, and probably treated with the appropriate dosage of amoxicillin. For most clinicians, treating otitis media is really routine stuff. However, most clinicians have not jumped on the "no antibiotic" bandwagon.
When amoxicillin first came out, maybe twenty years ago, it was dirt-cheap - only a few dollars for a standard, ten-day course. Children were treated, based on body weight, at about 20-30 mg/kg per day, in three divided doses. Amoxicillin virtually replaced ampicillin - an antibiotic that had some nasty gastrointestinal side-effects (like explosive diarrhea) and had to be given four times per day, a dosage nightmare for busy parents. The bubble-gum flavored amoxicillin even tasted better. For nearly a decade this dosage seemed to work great. Later, studies started to show that amoxicillin can be given twice a day, even more convenient for busy parents, and for as little as five days instead of ten.
My wife and I used to teach an all-day pediatric class for child care providers. I remember putting my lunch in their refrigerator, only to be shocked by the dozens and dozens of bottles of amoxicillin, all lined up for the various kids.
As the years progressed, everyone started using amoxicillin (a lot), still the drug of choice for otitis media. Unfortunately, amoxicillin started to fail as resistant strains took over. Many clinicians would abandon using it after the first-failure, until studies showed that a higher dose was more effective. Now, the standard dosage for amoxicillin (in children) is 60-80 mg /kg - more than twice the original dosage.
There are now about two dozen different antibiotics that can be used for pediatric middle ear infections. Every day in my clinic, I encounter the otitis media frequent flyers, usually on their way to the surgery center for tubes. There is a better way, but it is going to take a partnership of parent and medical provider to change the way we treat these kids. We need to trust that our immune systems have protected us long before the advent of antibiotics, and will continue to do so, IF we give them a chance.
Parents can help by not insisting on antibiotics, especially when clearly told that the child does not have a middle ear infection at the moment. Sure, they may get one tomorrow or over the weekend, or while you are at Disneyland, but that never justifies giving antibiotics prematurely.
Medical providers need to stand their ground and resist antibiotic solicitation from worried parents. Instead of medication, a healthy dose of EDUCATION needs to be administered. Parents who have children with frequent ear infections need to have a home otoscope, and learn how to use it. Medical providers have an obligation to cooperate with these novice otoscope-users, and encourage, not discourage their use. Parents should choose a medical provider that allows for this type of participatory care.
I still feel that antibiotics are miracle drugs, but the real miracle is to know when and how to use them. The bugs are getting smarter, and we need to be smart, too - always staying one step ahead.
Related Topics:
- Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
- Living Better Newsletter - Wellness news to keep you healthy and strong!
Labels: antibiotics, childrens health, ears, infection, medications, medicine
2 Comments:
My mother's (and hers before her, and hers before her, etc) treatment for ear pain: Hydrogen Peroxide and a couch or bed.
Worked for me the 2 times I needed it, why not others?
By the way, what does Hydrogen Peroxide actually do to a grumpy ear? Was always curious how it either worked 100% or not at all (Of course if the injury wasnt effected it didnt work, so what does it work for?)
Bob-A (Thats what they call me at dispatch, 2 Bobbys so we dont get confused)
Hydrogen peroxide may have worked for you, but I would caution anyone who has a perforated eardrum like I do from trying it. Ive heard that it, along with alcohol, can do more harm than good with a perforated eardrum.
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