Do All Ear Infections Need Antibiotics?

Our medical expert shares why administering antibiotics depends on the age of the child.

The Journal of the American Medical Association published a report recently that reviewed existing scientific literature on the standard treatment of ear infections with antibiotics. The purpose: To see if healthcare providers should be prescribing fewer antibiotics than they already are. There are a growing number of highly antibiotic-resistant bacteria, so we've got a potentially big problem on our hands -- no medicine to treat these germs! Doctors are trying to hold off on using their antibiotic "ammunition" unless they really need to.

What did the report find? Up to 80 percent of ear infections will clear up on their own without antibiotics. This isn't really a news flash for most clinicians. Doctors know that a good number of ear infections will subside without treatment (particularly in older kids). However, will this change the way doctors and parents approach ear infections?

Here's what I currently do in my own practice. For children who are older than 2, I offer the wait-and-see approach. I will hand a parent a prescription (ideally for Amoxicillin) but ask that he or she wait a couple of days to see if the child is feeling better before filling it. This approach applies to ear infections that occur on their own. But if an older child is running a fever of 102 degrees or higher and has other signs of a systemic infection (such as strep throat or a sinus infection), I will treat the child at the time I make the diagnosis -- I won't wait to start antibiotics if a child has an ear infection plus other signs of bacterial infection.

If a child younger than 2 has a really bad ear infection (especially if he is running a fever), I will treat it. Children that young are not verbal enough to tell a parent how they feel and therefore have a higher risk of complications. This includes mastoiditis, a very serious condition where the bacterial infection invades the skull bone and requires surgical drainage and IV antibiotics). I don't feel comfortable waiting around to see if they improve without antibiotics.

What people need to realize is that antibiotics are not risk-free. Besides the emergence of superbugs, we have to weigh possible side effects such as diarrhea, yeast infections, and allergic reactions. This is why when a child has recurrent ear infections, I am more likely to refer to an ear, nose and throat (ENT) doctor for possible Pressure Equalization (PE) tubes in addition to continuing antibiotics.

Look at the scientific evidence and discuss it with your doctor. Most adults have no idea how much ear infections hurt unless they have had one beyond childhood. If antibiotics will help shorten the duration of pain for some kids, that is not something we can discount. But if you feel comfortable caring for your child at home and waiting to see if he or she improves before filling a prescription, that is usually the best course.

Dr. Ari Brown is a pediatrician, a medical advisor for Parents magazine, and the author of Baby 411, Toddler 411, and Expecting 411. 

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