05 Nov 2010 4 Comments
Common cold, flu, and ear infection season is upon us, and whether your kiddo is picking up stray germs in that perfect culture medium we call the classroom, or sharing microbe-laden chewy toys at playgroup, it’s likely you’ll have a childhood illness or two coming your way this fall.
Before you can say back-to-school-night, your guy may start to look a little drippy. Next, come those three little words no mother ever wants to hear, “my ear hurts”. OH NO! It’s time to high-tail it to the pediatrician for some vitamin A, right?
Vitamin A, the magic elixir, the pink stuff, bubblegum medicine, fruit punch — all the nicknames you can think of mean the same thing. Amoxicillin. An antibiotic in the penicillin family that is used to treat a variety of bacterial infections (remember that word — bacterial — we’ll come back to it in a minute). Amoxicillin. Best friend and superhero of moms everywhere. It can fix anything AND kids actually ask for its pink, sticky goodness.
I’m here to tell you it ain’t necessarily so … Children’s ear infections, colds, and many other minor childhood illnesses don’t automatically need to be treated with antibiotics, amoxicillin or otherwise.
It has taken way too long for the American Academy of Pediatrics to change its recommendation, but based on serious research done in Europe we now agree that routinely treating all ear infections with antibiotics is not the best option.
Many ear infections are caused by viruses, and antibiotics won’t touch them because they’re only effective against bacteria. Colds and flu are caused by viruses, too, so antibiotics won’t help those either.
Ear infections are not contagious, although the associated cold that can trigger them is. The pain stems from the buildup of pressure in the middle ear. The degree of pain varies: some ear infections may go unnoticed, while others can be excruciating. The pain peaks in the first twenty-four hours, and rarely lasts for more than a couple of days.
For the longest time doctors believed antibiotics were the only way to treat the symptoms of ear infections. So almost every kid has ingested large amounts of that yummy pink stuff. But this widespread overuse has resulted in a serious problem: antibiotic resistance.
The more often bacteria are exposed to antibiotics, the more resistant they become. Because bacteria reproduce rapidly, these antibiotic-resistant bacteria spread like wild fire. Unlike higher organisms, bacteria can transfer DNA to other bacteria that are not their offspring, and even to members of completely unrelated bacterial species. In effect, bacteria can teach one another how to outwit antibiotics.
And lots of them have pulled an end-run on amoxicillin. In many communities the most common bugs laugh at our savior in pink. Doctors are forced to move on to bigger guns with more side effects and greater risk for resistance.
Increasingly, the standard of care for children with an ear infection is to soothe their pain with acetaminophen or ibuprofen and observe them carefully for signs of persistent infection. Pain medications are magical (unlike the pink stuff), and give relief quickly. Your kid will go from crying to singing as soon as they take effect.
If the infection doesn’t resolve on its own in a few days an antibiotic may be called for, but giving your child’s own immune system a chance to do its thing first is the way to go. The reality is that most ear infections, whether caused by a virus or bacteria, will heal just fine without antibiotics.
Unfortunately, despite the scientific evidence and the new recommendations, many doctors are still heavy-handed with the prescription pad when it comes to ear infections, partly due to their habit of dispensing gallons of pink medicine, and partly due to the pressure they get from moms who just love the stuff.
So next time your little one complains about a painful ear have your pediatrician take a look, but don’t ask for vitamin A. And if your doctor offers some, ask whether your child really needs it, or if it might be better to wait a few days and see if it that hurting ear clears up without it. If it makes you feel more secure, another option is to take a prescription and hold on to it for 3-5 days to see if the infection heals naturally.
But that takes some willpower. It’s awfully tempting to grab for the pink stuff, even if it is a lie. The Centers for Disease Control and Prevention says that decreasing inappropriate antibiotic use is the best way to control resistant organisms. To do that, we have to educate patients, parents and physicians about the need to use antibiotics more sparingly. Be strong. Just say ‘no’.
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