What to Do About Ear Infections

From the WebMD Archives

May 2, 2001 -- Researchers may have found a way to reduce the need for antibiotics to treat ear infections in children over 2: Treat the pain.

Children treated with eardrops that provide simple pain relief do as well as children who receive antibiotics, according to a study presented at this week's Pediatric Academic Societies' Annual Meeting. The strategy satisfies parents and goes a long way to reducing overuse of antibiotics.

"What we found was that children who received the eardrops got better at the same rate as the kids on antibiotics, and, almost as importantly, the parents were equally satisfied with either treatment," study author Paul S. Matz, MD, tells WebMD.

Matz, a researcher in the department of pediatrics at Rhode Island Hospital, studied 88 children, aged 2-18, with ear infections. About half were given a prescription for an oral antibiotic, while the other half received a prescription for eardrops containing a pain reliever called Auralgan to numb the ear. All the children were re-evaluated after three to seven days of treatment.

Overall, approximately 89% of the children who received pain-relieving eardrops got well, compared with 95% of children on antibiotics. The parents of children in both groups reported similar satisfaction ratings.

"The 89% of children who got better with eardrops were spared antibiotics that would have been given to them [automatically]," says Matz.

Health experts suspect a link exists between overusing antibiotics to treat ear infections and the explosion of bacteria resistant to antibiotics -- a serious public health concern. "The main issue is antibiotic resistance. There are approximately 20-25 million cases of [ear infections] each year in the United States, and 98% or so are treated with antibiotics," says Matz, adding that in The Netherlands only 30% are treated with antibiotics.

"There is a fair amount of research that has already been done to show that most kids [with ear infections] will get better without antibiotics, especially older children, and if we can decrease [the number of prescriptions] even by half, that's 12 million fewer antibiotic prescriptions each year and that contributes greatly to [reducing] antibiotic resistance," he says.

Why does an ear infection get better on its own?

"Essentially it is a self-limited illness," explains Matz. "It is something that came to be treated with antibiotics over the last 30-40 years, partly because there is a risk of complications. ... It just became the standard for a long time and no one thought about it. A fair amount of research, most of it from Europe, looked at it again and said actually most of these kids get better on their own."

Norman Carvalho, MD, tells WebMD that the valuable thing about the study is it addresses the issue of parents who are reluctant to accept no treatment for their child's ear infection. Carvalho, a staff pediatrician at Children's Health Care of Atlanta, was not involved in the study.

The high parental satisfaction with the eardrop treatment is important. "Parents want to walk away with a prescription in their hands," says Carvalho. "The thing is, if parents didn't want something they wouldn't come in really, because often it involves a wait in the waiting room. And if they come away with nothing they think, 'What did I come here for?'"

Pediatric ear, nose, and throat specialist Steven Handler, MD, agrees. "The U.S. has developed a culture of people who, when they go to the doctor's office, demand an antibiotic. Doctors who don't give an antibiotic are sometimes made to feel that they haven't done anything, but sometimes making the diagnosis and giving them information even though they don't need an antibiotic is very helpful," says Handler.

"We advocate, in some of the cases, that if the ears don't look that badly infected, and the kid is not that symptomatic, just him give Tylenol or Motrin," he says, noting that the pain-reliever will help the child handle the pain. Handler is associate director of pediatric otolaryngology at the Children's Hospital of Philadelphia, and a professor of otolaryngology/head and neck surgery at the University of Pennsylvania School of Medicine in Philadelphia.

But all three doctors agree there are times when a child does need an antibiotic to battle an ear infection.

"What you don't want is to be in a situation where you say don't give antibiotics, and a child develops a complication, like mastoiditis," when the infection spreads from the ear into the mastoid bone, which is part of the skull bones, says Handler. "That is where you have a problem ... and those are the situations that can be very dangerous. So it is not that no child should be treated with antibiotics, but [doctors] ought to be cautious."

Matz says that children who do not get better after 2-3 days -- who are still complaining about the pain and who have a fever -- and children under 2 (because they are believed to be at higher risk of complications), should be treated with antibiotics.

Parents should follow their child carefully. "A parent has to be assessing the child's overall activity level and fever," says Handler. "How is the child doing? How is the child sleeping, eating, and playing? Those are the kinds of things you have to look for. If the child is not any better in two to three days, go ahead and give the antibiotic."