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Antibiotics for Bilateral Otitis

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: My seven-month-old daughter was diagnosed with bilateral otitis and put on amoxicillin for seven days. Three days after completing antibiotics, she was diagnosed with another otitis and put on Pediazole. My pediatrician doesn't feel he needs to see her after the second course of antibiotics. Do you think that sounds right? If the Pediazole works, would Pediazole be the drug of choice for future ear infections?

A: Ear infections are one of the more common infections diagnosed by pediatricians in the office. They occur at least once to most kids by their pre-school years. We worry about ear infections because they can make it difficult for some children to hear and to learn to speak. The younger the child the more problematic that can be. Risk factors that suggest a child may have more ear infections than usual include having the first infection in the first year of life (particularly in the first six months), attending daycare, and having a family history of lots of ear infections (particularly parents and siblings).

There are numerous antibiotics that can be prescribed to treat ear infections, but no one magic bullet for every infection in every child. Which antibiotic to use in what order varies by region, by physician, and by patient's ear infection history. I often consider starting with amoxicillin again with a child's next new ear infection since it is pleasant tasting, has minimal side effects, works a majority of the time, and is not too expensive. Just because it didn't work with a previous ear infection, doesn't mean it won't work with the new one.

It sounds as if your daughter's first ear infection never totally got better, so changing to a broader spectrum antibiotic like Pediazole for this continuing infection was appropriate. At this young age I do tend to check ears some time at the end of the therapy to see whether the infection has cleared up or not. Pediatricians do have different styles about managing ear infections. I'm sure your daughter's pediatrician would be happy to discuss his ideas with you and to see your daughter, if you'd like.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.


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