Should your child take antibiotics for an ear infection?

Dr. Nina Shapiro: Millions of children visit the doctor each year for an ear infection. This translates to even more millions of antibiotics being prescribed for these infections. Many parents are rightly concerned about all of these antibiotics. While they are oftentimes necessary and beneficial, we have seen the negative effects of antibiotic overuse.

Most ear infections are caused by viruses similar to the cold virus, and may improve after a day or two of pain control with acetaminophen or ibuprofen. Antibiotics attack bacteria, not viruses. As is the case with a cold, ear infections sometimes just need to run their course. The American Academy of Pediatrics now recommends that, in some situations, measures to control pain should be instituted before going straight to antibiotics. Using too many antibiotics on a global level has led to "stronger, resistant" bacteria surviving. The increased survival of these "resistant" bacteria has led to difficulty in treating bacterial infections with antibiotics when we really need them. If we stop using antibiotics for every viral infection, the surge of "resistant" bacteria will subside.

How many ear infections, be they viral or bacterial, are too many? Many kids get up to three ear infections each year, and they usually clear within a few days, with or without antibiotics.

There are several scenarios where your child may need further evaluation:

• Four to six ear infections in a 12-month period;
• An ear infection where the fluid behind the eardrum doesn't go away after three months;
• An ear infection where your child has problems hearing for more than three months;
• Ear infections associated with high fevers, seizures, or ruptured eardrums;
• Ear infections that require several rounds of antibiotics before they go away.

These issues may warrant evaluation by an ear specialist. In some cases, ear tubes are recommended. These tiny tubes (each about 1 millimeter in diameter) prevent fluid from building up behind the eardrum, help the ear to drain if your child gets a cold, and improve hearing caused by a prolonged ear infection. While these tubes are by no means a cure-all for every child with ear infections, they can make a difference if ear infections have become a chronic problem.

Dr. Nina Shapiro is a graduate of Harvard Medical School, and she completed her residency in ear, nose, and throat surgery at Harvard. She is an Associate Professor and Director of Pediatric Ear, Nose, and Throat at the Mattel Children's Hospital at UCLA. She has treated tens of thousands of children with ear problems, sleep problems, and breathing problems. She lives with her husband and two young children in Los Angeles.