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Ear Infections and Antibiotics
Q: Our son (19 months) has had three ear infections in the past three months. His pediatrician has raised the possibility of using prophylactic antibiotics to treat him. Could you please give us your opinion on this? Also, if you could point us to any medical literature on the subject, we would appreciate it.
A: As I am sure you know by now, ear infections are very common in children. 80% of all children will have at least one ear infection in their first five years of life. Some children, however, seem to be more prone to ear infections than others. In general, boys get them more often than girls. Children who go to day care or who have siblings are at higher risk of getting ear infections. Additionally, children who are exposed to smokers get ear infections more frequently.
Ear infections are generally minor infections, and there are many children whose ear infections will resolve without any treatment. When children get into a cycle of having repeated ear infections one begins to worry about problems with diminished hearing, or scarring of the ear drums. The first way to address this problem is to try and prevent further ear infections. Just as your physician suggested, we give these children a low dose of an antibiotic to take once a day to prevent bacteria in the middle ear from growing and causing another infection.
Usually, children will be on these prophylactic antibiotics for a few months, or through the winter, when children are more prone to having ear infections as a complication of a cold. For most children this works quite well, and they do not have any ear infections. The antibiotics that we usually use are common ones like Amoxicillin, rather than the broad spectrum antibiotics. There is definitely some concern about building up resistance to antibiotics if you use stronger ones than you need to.
So how many ear infections are too many? In general, if a child has three ear infections in six months, or four in a year, physicians would consider starting that child on prophylactic antibiotics. It is important to determine if the ear infections are truly separate infections, however. With your son having 3 episodes in such a short time, I definitely would wonder whether they were all distinct ear infections or if one or two of them never cleared.
A small percentage of children will continue to have frequent ear infections, even on the prophylactic antibiotics, and they may need other treatment such as having tubes put in the eardrum.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.