childhoodCONDITIONS
Fifteen percent of kids who take an antibiotic suffer from diarrhea or vomiting.
EAR INFECTION?
why doctors usually say wait & see before treating
BY KAREN FINUCAN CLARKSON Ear infections are: a. the most common reason parents bring their child to a doctor. b. likely to clear up on their own. c. responsible for more than half of all antibiotic prescriptions for preschoolers in the U.S.
16 Gazette Health | Summer 2013
or life threatening,” noted the American Academy of Pediatrics (AAP) in a fact sheet explaining its new guidelines for diagnosing and treating middle ear infections, also known as acute otitis media, in otherwise healthy children. Also driving the guidelines, which were released in February, are concerns about antibiotic-resistant bacteria. More than 5 million cases of acute otitis media, the most common type of ear infection, occur annually in U.S. children. The result is more than 10 million antibiotic prescriptions and 30 million physician visits. “Using an observation option could reduce antibiotic prescriptions annually by up to 3 million and would significantly reduce the prevalence of resistant bacteria,” the AAP reported. A MIDDLE EAR INFECTION OCCURS WHEN FLUID
builds up behind the eardrum and is invaded by a virus or bacteria. “Bacteria love to party in warm, moist, dark places,” said Lester. “That’s why the onset [of an ear infection] is so rapid.”
A GAZETTE PUBLICATION
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All are correct. If you have a child, chances are he’s had an ear infection. If he’s had an ear infection, chances are he’s been prescribed an antibiotic. If he’s been prescribed an antibiotic, chances are he didn’t need it. “Most kids get better in 48 hours without treatment,” said Heather Schwartzbauer, M.D., an otolaryngologist with Chrosniak, Schwartzbauer & Mehta and privileges at MedStar Montgomery Medical Center, both in Olney. “Ear infections are overtreated with antibiotics. Parents don’t want to see their children suffer. But in healthy children over 6 months old with a robust immune system, watching them for 48 hours and giving Motrin or Tylenol to help with pain and other symptoms” is likely to yield the same result as treating with an antibiotic. What many parents don’t realize is that antibiotics can pose more danger to a child than an ear infection, said Norman Lester, M.D., an otolaryngologist with Clinton/Lakeside ENT and privileges at MedStar Southern Maryland Hospital Center, both in Clinton. He pointed to a study that “looked at over 4,000 kids [with ear infections] who didn’t get antibiotics, unless they didn’t improve in three days. In that entire study, only two kids developed mastoiditis,” an infection in the mastoid bone of the skull. “That’s a very low number. Think of how many people we make sick—rashes, stomach problems, or worse—with antibiotics.” “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
“Sudden fever, irritability, pulling on the ear or rubbing the ear,” are often signs of an infection, according to Schwartzbauer. Because ear infections are most common between the ages of 6 and 11 months, according to the University of Maryland Medical Center, “it can be really hard for a parent to tell,” said Schwartzbauer. It sometimes can be hard for a physician to tell, as well. The new AAP diagnostic guidelines call for the presence of both fluid and inflammation. “If you have a true, acute ear infection, the eardrum will be bright red and bulging. It will really look angry. More subtle is the presence of fluid,” said Schwartzbauer. “It’s like looking in a fishbowl and trying to decide if water is in there. Fluid is overdiagnosed.” What makes children more susceptible to fluid buildup than adults is the shape and angle of the Eustachian tubes, according to the Mayo Clinic website. The tube, which connects the middle ear to the back of the throat, regulates air pressure behind the eardrum and allows secretions to drain. Because Eustachian tubes in children tend to be narrower and more horizontal, they have a more difficult time draining and are more likely to get clogged, especially when irritated by allergies, colds or tobacco smoke. Pressure from the fluid trapped in the middle ear can cause pain. The AAP guidelines recommend the use of ibuprofen or acetaminophen for pain relief, especially during the first 24 hours. Antibiotics do not relieve pain in the first 24 hours and have only a minimal effect thereafter. Antibiotics should be the treatment of choice for ear infections in infants 6 months and younger and, when severe symptoms are present, in children up to 12 years of age. Otherwise, observation is encouraged. Children whose symptoms have not improved in 48 to 72 hours are candidates for antibiotic treatment.