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: Are antibiotics needed to treat ear infections?
DEAR DR.PAUL: My 3 year old son keeps getting ear infections
and seems to always be on antibiotics. I have heard that in Europe
antibiotics are not used to treat ear infections in children.
Am I giving my child antibiotics for nothing?
PEDIATRICIAN DR.PAUL Answers: Thank you for the question
which is shared by many parents as it brings up a very important
issue. Firstly, you are not alone, more than 70% of all children
will get a middle ear infection, or Otitis Media by the age
of 6 years.
The use of antibiotics to treat ear infections has been questioned
recently by those who argue that some ear infections, like colds,
are caused by viruses rather than bacteria. Antibiotics are
not effective in treating viruses, and many people are justifiably
concerned about the overuse of antibiotics. But in the case
of Otitis Media, it's often impossible to determine whether
the infection is caused by a virus or a bacteria, or whether
the infection will heal without the use of antibiotics.
Additionally it is impossible to know which bacteria is causing
the infection, as different bacteria have different rates of
resolving or going away on their own. However, studies have
shown that overall, roughly 30% of all middle ear infections
do not heal on their own without the use of antibiotic treatment.
This means that about 70% of infections go away on their own.
The difficulty is, that it is impossible, just by examining
the ear, to identify the 30% of children who will need the antibiotics.
Identifying these children is important, as untreated Otitis
Media has the potential to develop serious infectious complications
if bacteria from the infection spreads to other areas of the
body, including meningitis.
Knowing full well that the majority of ear infections will heal
on their own, it is because of these serious risks that antibiotic
treatment is still strongly recommended for children with Otitis
Media. Since antibiotics were introduced in the treatment of
Otitis Media, complications of the infection have dropped dramatically,
and are now considered rare.
Today, in certain situations, such as an older child with a
mild infection, some physicians may choose not to treat the
Otitis Media right away with antibiotics, but may rather follow
the child closely making sure that the infection clears on its
own. On the other hand, the infection may be very severe, and
especially in the younger child, an antibiotic is prescribed.
Which treatment approach a physician may select depends entirely
on the individual situation. Under these circumstances I do
not think a child with a confirmed middle ear infection is receiving
antibiotics for nothing.
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