What You Need to Know About Ear Infections

Beyond the Bubble-Gum Cure

For most children, the mainstay of treatment is still antibiotics. Amoxicillin, the pink, bubble-gum-flavored medicine, is still the first-line antibiotic recommended for typical ear infections, even for infants. Due to a large number of resistant bacterial strains causing ear infections, we now routinely use higher doses of amoxicillin than we previously did. If, on the other hand, your kid has had an ear infection treated with an antibiotic within the past 30 days, or has had a pattern of recurrent infections, your child's doctor may prescribe a broader-spectrum oral antibiotic, such as Omnicef and Cedax. Sometimes the bacteria causing the ear infection is so resistant that it will only respond to injectable antibiotics.

Not All Antibiotics are Created Equal

Keep in mind that what worked for your neighbor's kid, or even your child's older sibling, may not be right for your kid. In fact, just because one antibiotic may not have been effective for a prior episode with your child does not mean that it should never be used again.

Because the majority of ear infections go away on their own, the latest recommendations from the American Academy of Pediatrics give physicians the option of not using antibiotics to treat mild to moderate cases in children over 2 years old. I usually tell parents that their kids should give them some indication that they're feeling a little better within 48 hours, for example, their fever breaks, their appetite improves, or they sleep more soundly. If parents don't see any of these signs, then that particular infection may fall into the 25 to 30 percent of cases that don't get better without antibiotics.

Watch, Wait -- and Medicate?

When physicians use this watchful-waiting approach, they often give parents a safety-net prescription, telling them to fill it only if a child isn't feeling better after two days. This saves them a trip back to the office, and in my experience, many parents don't end up at the pharmacy anyway.

In light of this, you may wonder why doctors ever prescribe medication to treat ear infections from the start. First, kids younger than 2 years can't voice the severity of their discomfort. Plus, antibiotics appear to shorten the duration of symptoms by about a day or two, and in some instances, may prevent rare complications of ear infections.

Even when the pediatrician chooses to utilize the watch-and-wait option, she'll usually suggest that parents administer pain relievers at home. If your child is over 2 years old, your pediatrician might recommend using acetaminophen or ibuprofen to help manage the earache while you wait the infection out. There are many herbal and pain-reliever eardrops available, but only use them with your pediatrician's approval. If the eardrum is perforated as a result of the infection, certain eardrops can cause permanent damage to the hearing bones in the middle ear. The observation-only option has been used in Europe for decades, with great success, no higher incidence of hearing or language deficits in children, and with lower rates of antibiotic-resistant bacteria.

Other Helpers

Try these at-home techniques in addition to the course of treatment your pediatrician prescribes.

  • Heat: The application of moist heat to the outer ear can be very soothing. The best way to accomplish this is by placing a warm washcloth over the ear and leaving it there until it cools. This can be done several times per day. Heating pads and water bottles are not recommended, due to the risk of skin burns.
  • Sit upright: Children with ear infections often seem fine during the day when they are up and playing, but at night they are miserable due to increased middle ear pressure from lying flat. Placing your child in a more upright position for sleeping can make the nights much more bearable during an infection.

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