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| |    The Role of Antibiotics in Treating Ear Infections by Jerome O. Klein, M.D. reviewed and revised by Lynn Cates, M.D., F.A.A.P. and Laura Jana, M.D., F.A.A.P. You've probably heard that some ear infections go away without antibiotic treatment. Yet every time your child's healthcare provider diagnoses a middle ear infection, he prescribes antibiotics. No doubt, you're wondering why he does that, particularly when the overuse of antibiotics is leading to a dramatic rise in antibiotic-resistant infections. Don't worry--ear infections are valid indications for prescribing antibiotics. Before antibiotics were available, many children were hospitalized for complications of middle ear infections like mastoiditis and meningitis; some children even died. In those days, the only treatment available to healthcare providers was to slash the eardrum (perform a myringotomy) to allow the pus to drain from the middle ear. Today, thanks to the availability of antibiotics, such severe complications are rare. However, they can still occur if treatment is withheld or delayed, and they remain common in developing countries where children do not have access to good health care. How antibiotics work Antibiotics kill bacteria or prevent them from growing. They help treat middle ear infections by killing the bacteria in the infected fluid (or Sterilizing it) in the middle ear space. Once the infection has been treated, the inflammatory response resolves along with the child's fever, ear pain, and other symptoms. Antibiotics provide rapid clinical improvement and prevent the spread of bacterial infection to adjacent tissues; in some cases, they prevent the spread of infection throughout the whole body. With appropriate antibiotic therapy, a child with acute otitis media should improve substantially within 48 to 72 hours. If the child does not seem to be getting better, you should contact his healthcare provider. Reasons why a child might not respond to antibiotics:
Viruses that are not susceptible to antibiotics, so antibiotics don't work for viral otitis media. In addition, some bacterial infections of the middle ear clear spontaneously without the use of antibiotics. When you add together the children who have viral infections and the children who have bacterial infections that resolve without the need for antibiotics, the result is a majority of children who would get well without antibiotics. However, keep in mind that at least a quarter of children with middle ear infections do need antibiotics. Why antibiotics are prescribed for all middle ear infections Although some variation may be seen in the amount of bulging or the inflammation of the eardrum (or tympanic membrane), in the height of the fever, or in the pain associated with the infection, most ear infections look and act pretty much alike. Unfortunately, there is no practical way for a healthcare provider to distinguish between ear infections that will go away without antibiotics and those that can result in serious complications unless they are treated promptly. Because many ear infections are likely to be caused by bacteria that could cause complications if left untreated, the American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that all children with acute otitis media be treated with antibiotics. Middle ear fluid Fluid in the middle ear may persist for weeks or months after the onset of acute otitis media--even when appropriate antibiotics are used. Although effective antibiotics sterilize the fluid and decrease the period of time that fluid remains, the fluid still can be present for a long time. The average duration is about three weeks. The reason for the persistence of fluid in the middle ear is uncertain. Not surprisingly, children will have some degree of conductive hearing loss whenever fluid is present, since sound is not transmitted as efficiently through the middle ear space when it is filled with fluid than when it is filled with air. When the middle ear returns to a healthy aerated space, hearing returns to normal. The pain of middle ear infections Children with acute otitis media may be in pain because of the pressure of the fluid on the tympanic membrane. Treatment will provide some level of comfort fairly quickly--usually within two or three days. Acetaminophen or ibuprofen often can help bring down a fever and provide some pain relief. On occasion, the tympanic membrane will rupture because of the pressure of the accumulating pus behind the membrane. After this occurs, the pus will drain out the ear canal, relieving the pressure and, thus, the pain. Release of the pus also tends to be accompanied by overall improvement, including resolution of fever and other symptoms of the illness.
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