One of the most common concerns that parents have is about children with ear pain. There are many causes of ear pain besides ear infections, but middle ear infection (otitis media) is the most common reason for the use of antibiotics in children. Antibiotics are the standard treatment for otitis media except in the Netherlands where they are rarely used.
Before antibiotics were discovered, the major complications of otitis media were mastoiditis (an infection of the bone behind the ear) and meningitis (an infection of the covering of the brain). There are a number of reasons why we do not see these complications now besides the use of antibiotics. There may be a difference in our ability to fight infection because of better nutrition and health, a change in the "nastiness" of the bacteria associated with these infections, or possibly because the only ear infections that came to a physician’s attention before antibiotics were complicated cases.
Many studies have been done to look at the benefits of using antibiotics for ear infections. Many common bacteria are developing resistance to antibiotics and physicians are attempting to use them very carefully. These studies have shown that the routine use of antibiotics does little to decrease the duration of an ear infection, the severity of symptoms, or to prevent complications.
Typically the pain of otitis media lasts about three days with or without antibiotic treatment. Physicians in the Netherlands use more potent pain medications instead of antibiotics to make the children feel better until their bodies take care of the infection on their own.
We do know that young children, children in day care, and children exposed to cigarette smoke are more at risk for developing upper respiratory infections and ear infections. Even in these situations, the use of antibiotics has not changed outcomes considerably. Efforts to reduce exposure to smoke and other children with colds have better success.
Antibiotics have also been given for 7 to 10 days. The reasons for this length of treatment date back to early studies and little has been done since to see if this is appropriate. Recently some studies have looked the length of treatment in otitis. Many studies have shown that 5 days of antibiotics in older children is sufficient for treatment. Shorter exposure of bacteria to antibiotics may help to decrease resistance.
The treatment of otitis media, although a commonplace occurrence, needs to be reevaluated in light of the concern for antibiotic resistance and the evidence that antibiotic use in uncomplicated otitis does little to change the outcome.
