Ear Infection Shots

Dr. Alan Greene discusses the new shot for ear infections.


My 9-month-old gets ear infections all the time. The problem is he won't take antibiotics. He can recognize medicine a mile off. Right now we're trying to give him Septra, but he completely refuses. What do you think of the new shot for ear infections? Does it really work? What are the side effects?


Ear infection diagnosis in children continues to get more common each year. And more antibiotics are given to children for ear infections than for any other reason.

In January 1998, the United States Food and Drug Administration (FDA) approved Rocephin (ceftriaxone) as the first single-dose injection for the treatment of ear infections. But does Rocephin work?

Rocephin isn't a new antibiotic. For years it has been the most common injectable antibiotic used in doctors' offices. This very effective, very broad-spectrum antibiotic is the one we often turn to for seriously ill children (such as those with sepsis or meningitis, which can be life-threatening), or when the bacteria are resistant to oral antibiotics.

Although one early study found a single dose of Rocephin to be less effective than oral antibiotics, later studies have found it to be equally effective. One dose of Rocephin is equivalent to 30 doses of amoxicillin.

The common short-term side effects of Rocephin are relatively minor. Diarrhea, diaper rash, and allergic reactions could happen with any antibiotic. Worse side effects are uncommon.

But my grave misgivings about the overuse of this powerful drug concern the hidden, long-term effects -- specifically the development of antibiotic resistance.

We know that a child who has received two or three courses of antibiotics is seven times more likely to become infected with resistant bacteria. This problem is much worse when the child has been on a broad-spectrum antibiotic (an antibiotic that's effective against a wide range of bacterial species). Whenever antibiotics are used, the most sensitive bacteria die first, and the most resistant live to reproduce. When broad-spectrum antibiotics are misused, very resistant strains of bacteria can be bred.

This is even more likely with Rocephin. A single dose of this powerful drug is enough to kill most of the weaker bacteria in your child's body, yet still allow the stronger ones to survive. The likelihood of your child's getting a subsequent, worse ear infection only increases after this treatment.

The indiscriminate use of Rocephin will also increase the prevalence of resistant bacteria in your community. Soon, it will rob us of one of the most effective tools we have against serious infections. Already, resistance to this last line of defense is being reported.

Rocephin may be a good choice for a child who needs an antibiotic and is unable to take one orally. Still, I would only use it reluctantly. Rocephin is one of my favorite medicines, but I recommend it only when other alternatives don't make more sense. Its primary use should be for serious, systemic infections.

If Rocephin is to be used for an ear infection, I believe the best course of action is to follow it with an oral antibiotic or to give the injection daily for three days, so that the entire infection is wiped out -- not just the weaker bacteria.

Before allowing your child to receive Rocephin for an ear infection, first be sure that the ear infection really needs an antibiotic -- many don't.

Then I would recommend, if possible, choosing an oral antibiotic that's palatable (Augmentin and Cefzil, for instance, taste much better than Septra and are much more effective) or is given less often (once a day for Suprax or Cedax) or for a shorter duration (five days, once a day for Zithromax). Try mixing the medicine with pleasant, strong-tasting foods or liquids. You might also try squirting the medicine just inside the cheek -- outside the gums -- to avoid the taste buds on the tongue.

A single dose of Rocephin appears to be a wonderful, modern convenience. But used incorrectly it could create a health nightmare -- problems far worse than those it solves.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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