When a child has an earache, parents often ask the pediatrician for an antibiotic prescription. I asked Dr. Alan Greene of the popular Web site www.drgreene.com to explain more about why antibiotics often are not the right treatment for kids with ear pain. — Tara Parker-Pope
By Alan Greene, M.D.
Dr. Alan Greene. (Tami DeSellier)The old medical approach has been to routinely give antibiotics for acute ear infections. Ear infections are the top reason that antibiotics are given to children and the top reason that children get general anesthesia for surgery. It’s quick, easy and convenient for doctors to write an antibiotic prescription for ear infections, and parents want quick relief for their kids.
Simply giving antibiotics for ear infections doesn’t take into account where ear infections and ear pain come from. Nor does it take into account the consequences of these antibiotics — for us or the environment.
When antibiotics are given, kids are a bit more likely to get another ear infection sooner. And each time a child takes a course of antibiotics, future infections become harder to treat.
A typical healthy child carries a pound or two of rapidly evolving microscopic bacteria in his or her body. Antibiotics cause the selective breeding of the more resistant strains, which leads to the use of newer, harsher, more expensive antibiotics, with more side effects, creating a negative cycle. And some of the antibiotics given will end up in our water supply, as we’ve heard in the news recently, perhaps affecting wildlife as well as us.
Parents often want to start antibiotics for the ear infection because we’ve mistakenly taught them to think this will reduce their child’s pain. In the first 24 hours, though, there is no difference in pain level whether or not the child gets antibiotics.
We’ve also taught them to think that these medicines will help their child to recover. However, of about 10 million annual antibiotic prescriptions for ear infections, somewhere between 8.5 million and 9.5 million prescriptions didn’t actually help the children, according to the American Academy of Pediatrics.
Put another way, we have to treat between seven and 20 children with antibiotics for ear infections before one child benefits from the medicine. About 80 percent of ear infections will clear up easily without antibiotics.
In 5 to 14 percent of children, the antibiotics will take one day off the length of the ear infection. But by comparison, up to 15 percent of children who take antibiotics will develop vomiting or diarrhea, and up to 5 percent will have allergic reactions, some of which may be quite serious.
I believe antibiotics to be among the greatest inventions of the 20th century, but most children would be better off without the routine use of them.
Dr. Greene is the author of “Raising Baby Green.” Tara Parker-Pope is on vacation.
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From 1 to 25 of 94 Comments
The good doctor did not mention that most of these ear infections are caused by viruses, the same type of microbe that causes colds, flu, and most sore throats.
Thus, antibiotics are rarely effective agains ear infections for the same reasons they are mostly ineffective against these other diseases: they don’t work against viruses.
— jackPlanet Earth calling the good doctor.
Raised my kids in Berkeley where our pediatricians were committed lefties but possessed some serious common sense and empathy for the realities of child rearing. Better the kids get their “minty footballs” as we called their chewable antibiotics than cry all night writhing in pain for the sake of a greener world.
Can’t believe what suckers Americans are for the greening concept. A green America means fewer decent paying jobs, higher housing costs to comply with environmental regulation, and more war as a perverted way to stimulate the economy.
— MARK KLEIN, M.D.Thank you!
Reactionary prescribing of antibiotics doesn’t take into account even the cause of the ear infection. If it’s a viral infection, the antibiotic will do not one lick of good. And by helping resistant bacteria to breed as well as killing off the body’s beneficial and benign bacteria as well, can cause more serious problems over time than the initial infection.
I know parents want quick relief for their children’s pain. But they need to understand that that’s not what antiobiotics are for.
— Emily“A typical healthy child carries a pound or two of rapidly evolving microscopic bacteria in his or her body.”
2 pounds?! Wow, that’s pretty cool. And kinda gross!
You know, I keep reading that antibiotics shouldn’t be used for ear infections but the doctors in the practice I bring my children to all do it and not because I ask for them either. In fact, I always say, “but I thought antibiotics don’t really help ear infections,” and then they talk about the possibility of secondary infections or how the symptoms indicate this particular ear infection is bacterial and not viral. All of my friends and coworkers who I’ve discussed this with say the same thing. Apparently the AAP hasn’t convinced a lot of the pediatricians out there that antibiotics aren’t the way to go for ear infections, so I wouldn’t just assume that parents are to blame.
In spite of starting probiotics along with antibiotics, the meds cause some pretty funky digestive issues for my children and a yeast infection in my breast-feeding baby (which got passed along to me). Fortunately, we’ve only ever had 2 ear infections for my preschooler and 1 for my baby. My coworker’s child got reoccurring ear infections when he started day care, and was on antibiotics for 6 months!
— KSo when should a doctor prescribe an antibiotic for an ear infection? What information should go into that decision?
In general I’m inclined to avoid antibiotics when possible, but as a parent I need to know when it’s important to stress the urgency to my son’s doctor.
Thanks
— Sarah M-Sarah
I would have completely agreed before 3+ years of ear infections that my daughter has had. Maybe she falls in the small group for whom the antibiotics work, but we saw instant relief and improvement when we started antibiotics most times, and more importantly, when we waited to give them we never saw improvement. We used a probiotic called florastor to stop the diarrhea when she was on antibiotics.
We did see repeated ear infections over time, enough to convince us to get past our resistance to ear tubes when her hearing was compromised (they worked fabulously for us so far - healthy ears and good hearing).
The pain she was in seemed intense and persistent, interrupted her sleep and made communication difficult. Winters became a constant cycle of infection, brief recovery, infection. What you don’t mention is what you’d recommend in place of antibiotics. I don’t think “just wait it out” would work, given the harm that having an infection seems to cause. What options are there?
— JesseEmily above is right antibiotics won’t help viral ear infections. But that’s why it’s important to have the ear checked before prescribing.
Does Dr. Greene’s recommendation reflect the terribly high cost of pediatric care and medication today? Nowadays an office visit and medication could easily cost $500 plus. Very few parents have first dollar coverage anymore.
— MARK KLEIN, M.D.I have to agree that you should offer some alternative to antibiotics here. What do you want parents to use? If you’ve got another treatment, please mention it. Someone needs to come up with another treatment for childhood ear infections that spares children the pain. I had them myself in the late 1950s, and went through days of pain without an antibiotic. I do remember getting a little relief from warm compresses and “sweet oil”, but if antibiotics had been around to handle my sleepless, pain-filled nights, I’m sure my parents would have welcomed them.
— MantelliIn my experience young children are either susceptible or
resistant to ear infections. In kids with recurrent infections
(often caused by chronic antibiotic treatments), they often
run high fevers, are in miserable pain and in danger of the
infection invading the middle ear or going on a rampage
elsewhere. Being a responsible parent for these kids is
a hard job of decision-making in a context of little useful
information.
Are antibiotics the only treatment being evaluated?? Why is there
not more attention being paid to alternative support of a
very sick and uncomfortable kid? Having a list of support
treatments would be more helpful than a zero-sum discussion
of what doesn’t work. Are analgesics available or even useful?
Come on! Surely doctors can truly care for a patient besides
either giving in so that the patient’s mom goes away or sending
the parent home with no help.
ML
— Marquisa LGuidelines are available for doctors to help them decide which cases require and/or will benefit from antibiotics. Generally a waiting period of 2-3 days - WASP - “wait-and-see protocol” to see if there is spontaneous improvement is a good idea. Your provider may give you a prescription in the office, so that you have it on hand in case things don’t improve.
Readers will note below that this article is related to the topic of MRSA, the super-resistant staph infections that killed more people than AIDS in 2005.
I recommend parents use a phrase like, “I like to avoid antibiotics unless you really think they will help.” This also lets the provider know you’re not of the mind-set that antibiotics are required for every cold, flu, and other infection, and that you won’t be disappointed if you’re not given an antibiotic.
— Dan m.d.The good doctor apparently doesn’t remember or didn’t have ear infections when he was a child. My ear drum ruptured multiple times from ear infections (by the way, contrary to popular belief, that doesn’t make the pain much better). Antibiotics cured those ear infections and made the pain go away. But before they took effect the only thing that help were narcotics (codeine). BTW I’m in my 40s and I still remember the agony like it was yesterday (and I had my last serious infection at age 12).
It’s why, unlike my father, who came of age before antibiotics, I didn’t need tubes in my ears.
I am willing to concede that all ear infections are not the same. Perhaps more research needs to be done to establish which ear infections respond best to antibiotics. I know the vast majority of the ones I had would not have resolved themselves without weeks of agony. It’s very easy to say a treatment isn’t necessary if you’re not the one in pain.
— RebaI don’t know what I would have done without the orange triametic for congestion. Too bad so many parents abused the meds so now kids who are most suseptable (1-5) can’t be treated for that which most frequently causes the stuffed ears.
— AmyWhen my daughter had an ear infection, our ped recommended warm olive oil drops along with a gentle ear massage. My husband did it. It worked beautifully–almost instant relief. Mainstream doctors rarely actually touch their patients anymore. They use their hands primarily to write prescriptions.
— francoisAntibiotics for earaches, as Dr. Greene indicates, are over-prescribed. Really, the best method is sustained use of a good decongestant. It relieves the pain immediately and does not incur the problem of antibiotic resistance.
But the “antibiotics harm the environment” argument is almost as silly as the “the cause of antibiotic resistance is over prescription to humans” one.
The much bigger cause of antibiotic resistance is their routine use for livestock, not humans.
— LauraAt the International Neurological Institute in Hanover, Germany, I met an adolescent girl who had been operated on for a huge tumor inside her brain, just behind the ear. The girl was having trouble recovering the use of the nerves in her face on the side of the operation. Her father told me, and this was confirmed by her surgeon, that the girl had complained of earaches for over a year. She was taken to different doctors, each of whom saw a swelling inside and prescribed antibiotics. The girl was losing her hearing and the father was losing his patience. Finally, one doctor, at the insistence of the father, ordered a CT, and then an MRI, and the tumor causing the earrache was spotted. T
— deliaThis is not to say that all earaches are caused by tumors; rather, the indiscriminate use of antibiotics without searching for a cause of the pain can lead to dangerous misdiagnoses.
Try a few drops of 3% hydrogen peroxide in the afflicted ear every 4-6 hrs until the infection is gone. Alternate with warm olive oil to ease the pain.
— Debbie Georgens, RNI was another sufferer of chronic ear infections as a small child, and my bad ears continued into adulthood, when I finally got ear tubes — a godsend. Antibiotics did help, as I recall. What else are we supposed to do with serious and very painful ear infections?
I understand why one ought not overprescribe antibiotics, but this piece does not address what should be done instead. ?????
Don’t say warm oil. I experienced the most intense pain of my young life with ear infections, and warm compresses and oil did nothing for it.
— Lori BrownI’m 28 and sick with ear pain, post-nasal drip, headache, and lethargy for 11 days. Growing up, I had earaches every winter, and family doctors usually prescribed antibiotics. Now that I have different insurance, I can’t go to my family doctors anymore when I’m sick, so I use my university’s health service. I went to the service more than a week ago and was told that I didn’t have an earache; but my ears were malfunctioning in some vague way. The doctor told me to take Sudafed, irrigate my nose, and drink liquids. She didn’t say that I was contagious and had a virus. A week later, I felt only 10% better, so I went again and saw a second doctor. He told me that Sudafed and other nasal decongestants have been shown by JAMA not to work and to be possibly harmful, and that it was irresponsible for a physician to suggest them. He was willing to give me antibiotics because I asked, but I decided to trust his advice to use Chlortrimeton, Afrin, water, Tylenol, and Zicam. Five days later, he was surprised to receive my call that I wasn’t any better and wrote the prescription. I’ve had 3 doses of Bactrin and feel 60% better already. Another time, the service told me I didn’t have an ear infection and then a different family doctor said I did.
I learned two things: that since the health service doctors don’t know me I have to be the advocate who knows what’s worked for me in the past, and that the choice of physician influences the treatment more than the actual symptoms.
— KatherineThis seems a bit of a blanket condemnation. I got a terrible ear infection two years ago at 26 and actually couldn’t chew for a week until they started me on Cipro after amoxicillin did nothing to stop the infection, which began spreading. All the luymph nodes on the affected side swelled, as did the rest of my jaw. A course of Cipro coupled with Cipro ear drops saved my hearing, I was told. I tried heat and such and the pain just got worse and worse.
— EmilyI’ve been a pediatric nurse practitioner for 23 years, most of it in emergency rooms, and I go for the approach in post #10 (start antiobiotics if not improving in about 3 days). Motrin or Aleve or Tylenol give very effective pain relief for most people. Apart from my occupational experience, my kids had some ear infections when they were young, and I had about four between the ages of 25 and 25. The ones that were treated with antiobiotics didn’t resolve any faster than those that weren’t. As a few people have commented, many ear infections are viral, but most of the bacterial ones also clear up on their own.
— LisaWhen my children were small, I never traveled without a bottle of Auralgan drops in the kit. This product is a mixture of glycerol, which absorbs the excess water in the fluids behind the ear drum, benzocaine which provides immediate pain relief, and antipyrene which reduces inflamation. Usually, less than an hour and the child is asleep and the parents soon after.
I teach the medical students to use it for first time presentation uncomplicated by fever. Doubt that any of them remember that by the time they head off to residency, the drug reps have their talons into them by then.
— ProfbamFood allergies and intolerance are often culprits of ear pain/infections. Most commonly dairy, wheat, soy and eggs. Maybe an elimnation diet could help children suffering from chronic inflammation and infection.
— BarbaraI’ve always sought treatment for my children’s ear infections, not because they seem to be in terrible pain, but because my pediatricians warned me that recurring ear infections can lead to speech problems and permanent hearing loss. Frankly, that scares me.
I’ve never asked for an antibiotic, but when my kids had an ear infection, the MDs always prescribed one. Two of my kids had chronic ear infections, and ended up getting tubes by the time they were 3 years old.
I would like to know what the MD’s on this board think of over-the-counter otoscopes. We bought one, and my husband learned the signs of ear infections, so that we could cut down on trips to the doctor a little bit. (Our doctor didn’t like that, and said we shouldn’t be trying to diagnose ear infections at home; in my opinion, though, we have to guess if something was wrong or ‘just a cold’ anyway, and anything that helped us do a better job was a good thing.)
— AmyI’m wondering about what several posters here have suggested–ear drops– because it does not strike me as effective.
As a practical matter, if you put ear drops or a solution in the outer ear, how does it help an ear infection? Ear infections are almost always middle ear, behind the eardrum, where drops can’t reach.
— LauraSo, let me get this straight. It’s the 21 century; tax payers spend tens of billions of dollars every year on medical research through the the National Institutes of Health; consumers spend hundreds of billions of of dollars for medicines produced by the largest pharmaceutical manufacturers in the world, yet there is still no agreement or even effective treatment for childhood ear aches. It sure makes you wonder what all those physicians and biomedical researchers are doing to earn their salaries.
— WigWag