Are Antibiotics Really Needed for Ear Infection?

Up to 50% of antibiotics prescribed for children in the U.S. are used to treat ear infections. A growing concern is that widespread use of antibiotics has contributed to the development of antibiotic-resistant bacteria. Overuse and misuse of antibiotics makes future infections more difficult to treat and increases the spread of drug-resistant bacteria

The idea of "delaying antibiotic treatment"

Recent medical research is changing the way many doctors treat ear infections.

Some kids really need antibiotics, but most do not. Recent study has shown that two-thirds of the antibiotic prescriptions written to parents urged to delay treatment never got filled. The idea of delaying antibiotic treatment for ear infections is not new. The strategy is catching on in Europe, and the American Academy of Pediatrics says 80% of children whose ear infections are not treated immediately with antibiotics get better on their own.

Far too often people get antibiotics for earaches. Many supposed ear infections aren't ear infections at all, just earaches. Ear infections have fluid, by definition.

Antibiotics for ear infection

The 2004 American Academy of Pediatrics guidelines for the treatment of ear infections includes specific recommendation of how antibiotics should be used in different situations. Most ear infections do not need antibiotics at all.

If antibiotics are used, high-dose amoxicillin is the best choice for most children - along with treatment for their ear pain.

If the child is allergic to amoxicillin, then Ceftin, Omnicef, or Vantin are the preferred choices. If the child is also allergic to all four of these, then Zithromax or Biaxin are the recommended alternatives.

If the child with the ear infection has a fever over 102.2 F or is severely ill, then the best starting antibiotic is usually Augmentin.

Whatever the initial antibiotic, it should be changed if there is not clear improvement within 48 to 72 hours. High-dose Augmentin is usually the best follow-up choice.

Reasons to give antibiotics

Antibiotics will help the child feel better faster by eliminating the bacteria, which in turn reduces the fever and ear pain more quickly. Children generally feel better after one or two days of antibiotics.

Allowing an ear infection to heal on its own usually subjects a child to four to seven days of fever and ear pain.

Antibiotics help prevent the very rare, but possible, complications of an ear infection spreading into the brain or bone surrounding the ear.

Five things to know before giving antibiotic to children:

1. Antibiotics only work on ear infections that are bacterial in origin, they do nothing for those caused by viruses such as colds, allergies, mechanical obstructions, or nutrition.

2. Antibiotics do not permanently eliminate build-up fluid in the middle ear, the source of chronic ear infections.

3. A study in The Journal of the American Medical Association reported that children who took Amoxicillin for chronic infections were actually 2-6 times more likely to have a recurrence of fluid build-up.

4. Excessive antibiotic use can disrupt the balance of beneficial intestinal bacteria and can lead to digestive disturbances and recurrent infections.

5. Antibiotics do not help pain during the most painful first 24 hours, and help pain only minimally after that.