Ear infections - does every one in a child need to be treated with antibiotics? There is growing evidence that the answer is no, that in many cases the best treatment is pain medicine and watchful waiting. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) - the two leading groups of physicians who provide primary care to children in America - have recently recommended that physicians (and parents stop automatically putting every child with a possible ear infection on antibiotics.
There are several reasons for this, the two most important of which may be that antibiotics may not be necessary. First, many ear infections in children are caused by viruses, which are immune to antibiotics. When an ear infection develops as part of a typical cold picture - runny nose, cough, congestion, etc., that illness, including the ear infection, is often caused by a virus.
Second, the red ear with fluid behind it that a doctor sees when the child is brought to the office or the emergency department with ear pain may not actually be an acute infection, but rather a more chronic condition of fluid and inflammation still present from a previous ear infection. That ear also does not need antibiotics - pain medicine and time will take care of the acute pain, and the body will slowly clear the fluid and inflammation without antibiotics.
This does not mean that parents should no longer seek treatment for their child with the acutely painful ear. It does mean that treatment with antibiotics should no longer be a reflex; it should be the result of a careful assessment by the health care provider, then a thoughtful discussion between the parents and the doctor / physician assistant / nurse practitioner about what treatment approach is best. In order to take the watchful waiting / no antibiotic approach the parents also need good pain medicine for the child, something they should plan ahead for with the patient's doctor so that when the ear gets painful in the middle of the night, good pain treatment is in the medicine cabinet, not in the emergency department.
Finally, studies have shown that parents who pressure the health care practitioner for antibiotics are more likely to get them for the child. In doing so they may get what they want for their child, but they may not be getting the best treatment. Over the long haul, widespread and careless use of antibiotics causes all of us to develop bacteria which are resistant to usual antibiotics, and resistant bacteria in the long haul are not worth antibiotics in the short haul.
So the next time your child gets a painful ear and seems to have an ear infection, don't look for antibiotics from the health care practitioner; look for common sense, information, and a careful plan of care for the child. That plan may or may not include antibiotics.
Dr. Erik Steele, DO