Tuesday, June 01, 2004
Surviving an ear infection, sans antibiotics :::::::::::::::::::::::::::::::::
In the future, be prepared to wait it out rather than rely on antibiotics to treat ear infections.
Two new recommendations from the American Academy of Pediatrics are designed to decrease the growing problem of antibiotic resistance among kids. They urge parents and doctors to "watch and wait" rather than first turning to antibiotics.
The Centers for Disease Control and Prevention estimates at least 6 million prescriptions for unnecessary antibiotics are written yearly-some of them inappropriately and sometimes a result of parental pressure.
"The biggest problem is inappropriate prescribing of antibiotics," says Dr. Richard Besser, medical director for the CDC's National Campaign for Appropriate Antibiotic Use. "Tens of millions of antibiotics prescribed in doctors' offices are for viral infections, which are not treatable with antibiotics."
The CDC has developed a curriculum about antibiotic resistance to educate future doctors now in medical school that is being promoted by The Association of American Medical Colleges.
But the Academy's guidelines are meant for doctors now in practice. The recommendations are similar for fluid in the middle ear, known as otitis media with effusion, and for ear infections, known as acute otitis media, which include intense signs and symptoms of infection and inflammation.
"The proper treatment is patience, which is tough for the U.S. public," says Dr. Richard Rosenfeld, co-chairman of the academy's Subcommittee on Otitis Media with Effusion. "We don't want to do things that are unnecessary."
The group is also urging doctors and parents not to put ear tubes in the middle ear to drain fluid unless the problem lasts four months or more and causes persistent hearing loss, balance problems or delayed speech.
When fluid lasts longer than three months, hearing tests should be performed. If there are signs of hearing loss or learning problems, language tests should be done.
Most cases of fluid in the middle ear clear up within three months, while many ear infections go away on their own within one to two weeks.
The annual cost of treating fluid in the middle ear is about $4 billion for the 2 million U.S. children estimated to have the condition. Most of that cost is the antibiotics and surgery to implant ear drainage tubes, according to the Academy. But there may be a higher cost. A new study from University of Illinois-Chicago researcher Kamal Eldeirawi, in the May issue of the medical journal Chest, finds a link between ear infections and asthma, which may be the bacteria that causes ear infections, or the overuse of antibiotics.
While the Academy's guidelines aren't binding, they urge doctors to wait 48 to 72 hours to see how a child responds to pain relievers, such as ibuprofen-or ear-numbing drops in cases of severe pain-before using antibiotics. The vast majority of ear infections will get better on their own in two to seven days with no increased risk of a more serious infection. Antibiotics still may be the right choice for children 2 and under with ear infections. They may also be appropriate if a child is very sick or has a high fever.
Parents can influence whether doctors prescribe antibiotics, according to a survey done by the Mattel Children's Hospital at the University of California-Los Angeles. Doctors prescribed antibiotics 65 percent of the time when they perceived parents expected them, 47 percent when doctor's were uncertain and only 12 percent when parents had no expectations.
"There needs to be a partnership between the parent and the pediatrician on how best to treat the child," says Dr. Thomas DeStefani, pediatrics chairman at the Ronald McDonald Children's Hospital of Loyola University Medical Center. "It shouldn't just be a parent walking in and not being satisfied unless their child gets an antibiotic."
When parents understand the health risks, they are not as likely to pressure doctors. "I've found that many parents understand why it's important that their child not be put on antibiotics, and they actually appreciate it," he says. "An antibiotic isn't going to do anything for a child's pain." Warm compresses and elevating a child's head can help relieve pressure in the ear.
"We need to remember that if we keep popping out antibiotics like candy, they're not going to work when we really need them," DeStefani says.
Vaccine shortage One cause of middle ear infections, streptococcus pneumoniae, has been significantly reduced thanks to a vaccine introduced in 2000. The Prevnar vaccine, manufactured by Wyeth Pharmaceuticals, has helped cut this bacteria's infection rate nearly in half from 2000 to 2002, according to the Centers for Disease Control and Prevention. The vaccine, for children up to age 5, is currently only recommended-not required-for Illinois children. But currently, there is a Prevnar shortage-expected to last at least through July. So, the CDC suggests until then, healthy children skip the last two doses. Jennifer Mesich
Susan Dodge is Ben's mother and a writer living in northwest Indiana