All About the Kiddos!

Acute otitis media (middle ear infection) is the most common bacterial illness in children and the one most commonly treated with antibiotics. There has been a significant increase in, and concern about antibacterial resistance of the organisms that cause middle ear infections.

Guidelines for treating middle ear infections and trying to keep antibiotic use to a minimum:

1. Relieve pain, especially in the first 24 hours, with ibuprofen or acetaminophen.
2. Minimize antibiotic side effects by giving parents of select children the option of fighting the infection on their own for 48-72 hours, then starting antibiotics if they do not improve. Your health care provider will be able to tell you if your child needs antibiotics right away or if they can wait.
3. Reduce risk factors. For babies and infants these include breastfeeding for at least six months, avoiding “bottle propping,” and eliminating exposure to passive tobacco smoke.
4. If antibiotic treatment is agreed upon, the clinician should prescribe amoxicillin for most children.
Do the guidelines apply to all children?
No. The guidelines apply only to an otherwise healthy child without underlying conditions that may alter the natural course of middle ear infection. These conditions include, but are not limited to, anatomic abnormalities such as cleft palate, genetic conditions such as Down syndrome, immune system disorders, and cochlear implants. Also excluded are children with a clinical recurrence of middle ear infection
within 30 days or middle ear infection with underlying chronic external ear infection.
What is acute otitis media?
A diagnosis of acute otitis media requires:
• Recent, usually abrupt, onset of illness.
• The presence of middle ear fluid, or effusion.
• Signs or symptoms of middle ear inflammation.
Over 5 million middle ear infection cases occur annually in US children, resulting in more than 10 million annual antibiotic prescriptions and about 30 million annual visits to doctor’s offices. Fifty percent of antibiotics for preschoolers in the US are prescribed for ear infections. Using an observation option could reduce antibiotic prescriptions annually by up to 3 million and would significantly reduce the prevalence of resistant bacteria.
What are the harmful effects of antibiotics?
Each course of antibiotic given to a child can make future infections more difficult to treat. The result is an increase in the use of a larger range of – and generally more expensive – antibiotics. In addition, the benefit of antibiotics for middle ear infection is small on average, and must be balanced against potential harm of therapy. About 15 percent of children who take antibiotics suffer from diarrhea or vomiting and up to 5 percent have allergic reactions, which can be serious or life threatening. The average preschooler carries around 1 to 2 pounds of bacteria – about 5 percent of his or her body weight. These bacteria have 3.5 billion years of experience in resisting and surviving environmental challenges. Resistant bacteria in a child can be passed to siblings, other family members, neighbors, and peers in group-care or school settings.
When should antibiotics be prescribed?
• For children age 6 months and younger – for certain or suspected middle ear infection.
• Children age 6 months to 2 years – for certain middle ear infections or suspected middle ear infection with severe symptoms; observation is an option for suspected or uncertain middle ear infection if non-severe.
• Children age 2 to 12 years – antibiotic treatment for certain middle ear infections with severe symptoms; observation is an option for suspected or non-severe middle ear infection.
Approximately 80 percent of children with AOM get better without antibiotics. And children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.
What if a child with a middle ear infection is in great pain and discomfort?
The mainstay of pain management for middle ear infection is medications such as acetominophen and ibuprofen, not antibiotics. Most children with middle ear infection have significant ear pain, which may manifest in young children as ear rubbing, sleep disruption, or temper tantrums. Analgesics are most important in the first 24 hours after diagnosis, especially before the child’s bedtime. Fortunately, by 24 hours about 60 percent of children feel better, rising to 80-90 percent within a few days. Antibiotics do not relieve pain in the first 24 hours, and have only a small effect after that.
Is my child at risk for developing other infections if she is not treated with antibiotics?
Published trials of observation, placebo, or non-antibiotic middle ear infection therapy have shown no increased rate of complications, provided that children are followed carefully and receive antibiotics if symptoms persist or worsen. These studies vary in the age of children studied and the severity of illness, factors taken into consideration in determining which children are suitable for the observation option.

Take care,

Dr. Ray