Are antibiotics needed to treat ear infections?-Ask Dr. Paul Library

DEAR DR.PAUL: My 3 year old son keeps getting ear infections and seems to always be on antibiotics. I have heard that in Europe antibiotics are not used to treat ear infections in children. Am I giving my child antibiotics for nothing?

PEDIATRICIAN DR.PAUL Answers: Thank you for the question which is shared by many parents as it brings up a very important issue. Firstly, you are not alone, more than 70% of all children will get a middle ear infection, or Otitis Media by the age of 6 years.

The use of antibiotics to treat ear infections has been questioned recently by those who argue that some ear infections, like colds, are caused by viruses rather than bacteria. Antibiotics are not effective in treating viruses, and many people are justifiably concerned about the overuse of antibiotics. But in the case of Otitis Media, it's often impossible to determine whether the infection is caused by a virus or a bacteria, or whether the infection will heal without the use of antibiotics.

Additionally it is impossible to know which bacteria is causing the infection, as different bacteria have different rates of resolving or going away on their own. However, studies have shown that overall, roughly 30% of all middle ear infections do not heal on their own without the use of antibiotic treatment. This means that about 70% of infections go away on their own. The difficulty is, that it is impossible, just by examining the ear, to identify the 30% of children who will need the antibiotics. Identifying these children is important, as untreated Otitis Media has the potential to develop serious infectious complications if bacteria from the infection spreads to other areas of the body, including meningitis.

Knowing full well that the majority of ear infections will heal on their own, it is because of these serious risks that antibiotic treatment is still strongly recommended for children with Otitis Media. Since antibiotics were introduced in the treatment of Otitis Media, complications of the infection have dropped dramatically, and are now considered rare.

Today, in certain situations, such as an older child with a mild infection, some physicians may choose not to treat the Otitis Media right away with antibiotics, but may rather follow the child closely making sure that the infection clears on its own. On the other hand, the infection may be very severe, and especially in the younger child, an antibiotic is prescribed. Which treatment approach a physician may select depends entirely on the individual situation. Under these circumstances I do not think a child with a confirmed middle ear infection is receiving antibiotics for nothing.

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