PRESCRIPTIONS
Tot's ear infection may clear up by itself
By Landis Lum
Q. My 3-year-old had a cold and ear infection last week, and the doctor suggested the option of not treating it with antibiotics but rather waiting a couple of days to see if it would clear up on its own. Is this something new?
A. Actually, in the Netherlands, keiki with middle ear infections are usually just given pain medicines and watched closely. Antibiotics are given only if there is no improvement within one to two days in children younger than 2 years and within three days in kids above age 2.
This reflects the fact that our immune systems will take care of the vast majority of ear infections (otitis media) without antibiotics: 60 percent of children will be pain-free within 24 hours with or without antibiotics, with continued improvement over the next few days.
Antibiotics do not reduce the chance of continued middle ear fluid in the months after an ear infection. It's also the case that you'd have to treat eight children with antibiotics to have one less child with ear pain that lasts longer than three days. Again, this is because four out of five keiki will have cured their infection on their own in one week, even without antibiotics. Antibiotics improve this cure percentage by only 13 percent.
Furthermore, antibiotics can cause vomiting, diarrhea, drug resistance, allergic reactions and rashes.
The Oct. 10, 2002, issue of the New England Journal of Medicine agreed that if your doctor didn't see bulging ear drums, then giving your keiki acetaminophen (Tylenol) for pain and waiting 48 to 72 hours to see if the ear pain and other symptoms go away on their own before prescribing antibiotics was appropriate. This is especially true for cases of recurrent otitis media, because as you become more familiar with the pattern of your child's illness, you'll be able to recognize that most episodes will resolve without antibiotics.
However, I'm still chicken, and I still give antibiotics to keiki less than 2 years old, and to those with high fever, vomiting, or who look really sick.
For frequent ear infections, I'd also give your child a flu shot every October — this will reduce ear infections by 33 to 36 percent.
Which antibiotic is best? Amoxicillin is the drug of choice — it's just as good as more expensive drugs like azithromycin and with less chance for side effects.
Sometimes less is more.
Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
