Treatments for Middle Ear Infections
The goals of treatment are to eliminate the infection and prevent hearing loss and other complications.
Antibiotics are generally used to treat ear infections in children under two, but these medications only work against bacterial infections. If the infection is caused by a virus, the antibiotics will not be effective. The only certain way to tell if the infection is caused by bacteria is to perform a ]]>myringotomy]]> and culture the middle ear fluid, which are not frequently done.
In recent years, we have come to realize that antibiotic use for any reason causes bacteria to develop resistance to the antibiotic used. These resistant bacteria can then cause new infections in a child or be passed to family members or other children. Antibiotic resistance is a very serious problem—particularly when, unlike most cases of otitis, the infection is serious or life threatening. Experts feel that our best protection against “running out of antibiotics” is to reduce prescribing these drugs for illnesses that are likely to get better on their own without treatment. Since 80% of children with otitis will be much improved within two days–even without antibiotic treatment, reducing the use of antibiotics in children with otitis is an important health goal worldwide.
Many experts now believe that the risk of antibiotic treatment may be greater than its benefit for many children with an ear infection or suspected ear infection. In these children symptoms of infection will often subside just as quickly without an antibiotic. A pain reliever is frequently all that older children need to recover fully from an ear infection. In some circumstances, an observation period without the use of antibiotics may be recommended by your physician.
If symptoms continue for more than a few days or worsen, then an antibiotic can be prescribed. Some doctors will even give parents a prescription for antibiotics, but instruct them not to use the antibiotic unless pain or fever persists beyond an agreed-upon number of days. Encouraging findings from a recent clinical trial (involving nearly 300 children aged 6 months to 12 years with severe otitis media seen in an emergency department) reveal that "wait-and-see" prescription of antibiotics—where parents are asked not to fill the prescription unless their child is either not better or is worse in 48 hours—is as effective as standard prescription. ]]>*]]>
When an antibiotic is prescribed, it is important that you follow the dosage recommendations carefully. Failure to finish the medicine can make the medication less effective in the future. Sometimes the antibiotic initially prescribed does not clear the infection, and another medicine may be recommended. Be sure to go to a follow-up visit with your healthcare provider to determine whether the infection is resolved or requires further treatment.
Other medications that can help treat otitis media include decongestants, in the form of pills or nasal sprays.
Treatment involves the following:
Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ .
National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ .
*Updated section on "'wait-and-see' prescription of antibiotics" on 10/12/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA . 2006;296(10):1235-1241.
Last reviewed November 2008 by ]]>Elie Edmond Rebeiz, MD, FACS]]>
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