Most ear infections are caused by Streptococcus pneumoniae, a bacterium that can also cause meningitis, pneumonia, and other infections. Last year, a study identified a new strain of strep (dubbed 19A) that is resistant to all 18 antibiotics that are approved by the FDA for use in children. Kids in the study with those ear infections were successfully treated with an antibiotic meant only for adults, but one child suffered permanent hearing loss. Doctors also now realize that MRSA can cause ear infections as well as skin infections.
Since many mild ear infections clear up on their own, your doctor may recommend a wait-and-see approach for two to three days if your child is over age 2 and his infection isn't severe (based mostly on the appearance of his eardrum). You can get a prescription for an antibiotic to fill only if your child doesn't improve. "Most of my patients' parents never fill those prescriptions," says Dr. Hiramatsu.
For a more severe infection, your doctor will probably choose an antibiotic based on established guidelines (resistance varies regionally). "If your child is given two rounds of antibiotics within a month and still has an ear infection, there's a good chance the bacteria are resistant," says pediatrician Michael Pichichero, MD, director of the Rochester General Hospital Research Institute, in New York. In that case, the American Academy of Pediatrics recommends an ear tap (tympanocentesis), which is the only way for a doctor to pinpoint the strain of bacteria and find out which antibiotic will kill it. Unfortunately, few pediatricians do the procedure, which involves putting a needle into a child's eardrum.
"Tympanocentesis was very common when there were only a few antibiotics available, but pediatricians are no longer taught how to do it in medical school," says Dr. Pichichero. "I think that will change as more and more pediatricians are confronted with ear infections they can't cure with any antibiotic."
An ear tap can also be a form of treatment, since it drains infected pus from behind the eardrum. Karen Winters, of Hilton, New York, saw the results of an ear tap firsthand with her 2-year-old son, Anders, who's had several hard-to-treat ear infections. "He didn't like having us hold him down, but he felt better immediately afterward," she says.
If your doctor doesn't do the procedure, see if you can locate an ear, nose, and throat specialist who might. Otherwise, your doctor will keep trying different antibiotics and may eventually refer your child to have tubes placed in her ears to drain lingering fluid. Inserting tympanostomy tubes is now the most common surgical procedure performed on children; it's estimated that nearly 7 percent of kids have tubes in their ears by age 3.
Make sure that your child is fully vaccinated. Ear infections have declined dramatically since the pneumococcal vaccine was first introduced in 2000. Encourage him to wash his hands frequently to avoid catching colds that can lead to ear infections.