A concern about over-prescribed antibiotics has led to recent changes in ear infection treatment.
A concern about over-prescribed antibiotics has led to recent changes in ear infection treatment. Each time a child receives a course of antibiotic treatment, bacteria can become resistant to the antibiotic, making it more difficult to treat future infections. This leads to an increased use of a greater number of more expensive antibiotics. Therefore, in most cases the preferred method of ear infection treatment, for otherwise healthy individuals, is pain management with over-the-counter medication and/or other home remedies. However, if symptoms are severe, or if they persist for more than two days, antibiotics may be warranted.
Managing the pain and allowing the infection to run its course is often all that is necessary for treating acute middle ear infection. A warm compress may help to relieve the pain, as can over-the-counter pain relieving eardrops, ibuprofen or acetaminophen. However, antibiotic treatment may be necessary if a child has an underlying condition such as a cleft palate, a genetic condition such as Down syndrome, an immune system disorder or cochlear implants. A child experiencing a second acute middle ear infection within 30 days of the first may also require prescription treatment.
The American Academy of Pediatrics (AAP) states that antibiotics should be prescribed for acute middle ear infection in infants under six months of age, as well as in older children with severe symptoms. Roughly 80 percent of middle ear infections in children heal without antibiotics, and delaying treatment does not lead to serious illness. Therefore, the AAP suggests observing older children for symptom improvement for 48 to 72 hours before starting antibiotic treatment. The benefit of an observation period is a reduction in antibiotic prescriptions, thereby reducing the prevalence of drug-resistant bacteria. Drug resistance can be passed from the patient to other family members or other children in a group care setting, creating a widespread problem.
Surgery may be necessary for children if antibiotic treatment of middle ear infection is ineffective. The surgical procedure involves opening the eardrum to relieve pressure and to allow the fluid to drain out. Sometimes the surgery involves inserting ear tubes into the eardrum. The tubes create a small opening for air to get inside and encourage fluids to drain down the ears eustachian tube.
Surgery to remove enlarged adenoids may be considered if an individual has recurring ear infections or if ear infections continue after age four.
For children over six months, the American Academy of Family Physicians recommends letting middle ear infection with effusion (or fluid) heal without prescription treatment. If the child is uncomfortable, an over-the-counter pain reliever or a warm, moist cloth on the ear may help manage the pain.
Children meeting certain criteria may be candidates for antibiotic treatment of middle ear infection with effusion. If a child is younger than six months, frequently suffers from middle ear infections, has fluid remaining in an ear a few months after an infection or is experiencing hearing loss, antibiotics may be recommended.
According to the American Medical Association, a panel of medical experts has developed guidelines for the treatment of acute outer ear infection, or swimmers ear. These guidelines state that eardrops should be the first treatment option. Eardrops are preferred because they provide relief but do not promote antibiotic-resistant bacteria. The panel recommends that oral antibiotics should only be used if the infection spreads beyond the ear canal or if other symptoms suggest a need for additional treatment.
The course of treatment for getting rid of infection and allowing the ear canal to heal involves cleaning, medicating with eardrops and protecting the ear. First, the doctor will remove any discharge, earwax or flaky skin from the ear so the medicated eardrops can reach the infected area. The medication prescribed will depend on the exact nature of the outer ear infection. The drops may contain a combination of acidic solution, steroid, antibiotic and/or antifungal medication. Swimming, scuba diving and flying should be avoided during the treatment period. Additionally, earplugs or hearing aids should not be worn, and care must be taken to keep water out of the ear canal when bathing.
Treatment is generally effective for outer ear infection. However, to ensure the medicated drops have maximum benefit, a patient should lie on his or her side while another individual puts the eardrops in the ear if possible. Remaining in that position long enough to allow the medication to trickle down to the ear canal is also helpful. If inflammation or discharge blocks the ear canal, a doctor may need to insert a wick to help guide the medication to the site of the infection.