Gainesville, GA—Few creatures are as miserable as a small child with a raging ear infection. Emily Bailey of Flowery Branch, has witnessed this five times since Bridget, her three-year-old daughter, was born. “A sick child is not a happy child,” Bailey said. “They are clingy and require lots more attention to comfort them through the sick times. I think it is sometimes harder on parents to see their little ones sick than it is for them to suffer through it.”
Bailey takes her daughter to the pediatrician as soon as symptoms strike, which is usually after what she calls “a persistent cold that doesn’t budge for at least a week.” Kathy Morse, a nurse practitioner at Pediatric Associates in Braselton, Ga., says Bailey is doing the right thing.
Parents should consult a doctor right away if a child aged two or younger has a high fever, pulls at their ears and cries when sucking or sleeping – classic signs of acute otitis media.
Because severe, untreated ear infections can permanently damage hearing, Morse prescribes antibiotics to children with lingering ear infections. And she is quick to prescribe antibiotics for infants under two because they usually don’t heal as well on their own.
A new study highlights the wisdom of this approach. Researchers from the University of Pittsburgh School of Medicine divided 291 children, all under age two and suffering acute otitis media, into two groups. One group was immediately given Augmentin (a common antibacterial drug), and the other received an inactive pill. After 7 days, researchers found that about three quarters of infants in both groups had improved— they were no longer crying or pulling on their ears. This signaled that in the short run, antibiotic treatment didn’t make much difference.
The real benefits of antibiotic treatment showed up after 12 days when doctors checked the kids’ ears for evidence that the infection was still there even though symptoms had lessened. Of the 144 infants given Augmentin, only 23 still had signs of acute otitis media; of the147 left untreated, infection persisted in 75.
Bailey says she usually sees a noticeable improvement in her daughter’s symptoms after the third day of antibiotic treatment. She said that only one occasion the infection did not clear after the first round of antibiotics so her doctor had to prescribe a stronger dosage.
Although these results favor immediate treatment, they are unlikely to be the last word in an ongoing debate about whether ”watchful waiting” or immediate antibiotic therapy is a better approach to treat common childhood ear infections. Some say that the rush to prescribe antibiotics for every ear infection yields drug resistance. But Dr. Jack Paradise, co-author of the University of Pittsburgh study, believes the argument for immediate treatment of infants under two is persuasive.
“In a very young child, the condition causes immense pain, and even if symptoms go away on their own, there still may be a lingering infection that can cause permanent hearing damage,” Paradise said. He added, “It is not the responsibility of the child to eliminate unnecessary anti-microbial treatment, it is the doctor’s.”
The real culprit in development of antibiotic resistance is not treatment of a single childhood ailment, but instead “antibiotics apparent in everyday life, from agriculture, cattle, chickens, and prescriptions for other respiratory problems.”
Gainesville pediatrician Eugene Cindea agrees with Paradise’s recommendations for treating ear infections in very young children, but gives more credence to the idea that using antibiotics in this way may contribute to drug resistance.
“Development of antibiotic resistance in children is certainly related to antimicrobial over-exposure,” said Cindea, who practices at the Longstreet Clinic in Gainesville. “Doctors must be careful and judicious in the prescription of antibiotics for ear infections. A physician should never treat a patient over the phone or prescribe medicine on the basis of symptoms before thorough examination.”
When a child has a mild ear infection or is older than two, Cindea waits and watches to see if the problem spontaneously heals.
In fact, “85 percent of infections in children over 2 years old clear up on their own,” Morse said. For older children, she usually prescribes eardrops for pain and suggests acetaminophen or ibuprofen.
Waiting for an ear infection to clear on its own can be agonizing for parents of a slow-healing child. “For us, watching and waiting has failed more times than it has succeeded,” Bailey said. “When we take the waiting path, it’s usually a long road to recovery that takes twice as long than with antibiotic treatment.”
What parents really want to know, of course, is whether ear infections can be prevented. “I usually tell adults to marry someone with good genetics,” said Cindea. “Outside of good genes and taking their children out of daycare, there isn’t much they can do. Ear infections aren’t preventable.”