Antibiotics and Ear Infections

Baby with ear acheWhen you catch a cold or some other viral infection the best treatment is usually rest, fluids and painkillers — acetaminophen or ibuprofen. And don’t forget lots and lots of TLC!

It’s important to keep a close watch on children with a viral upper respiratory illness because they’re apt to get a secondary infection, such as otitis media (ear infection) or pneumonia.

Signs of bacterial and viral pneumonia

Pneumonia is a serious lung infection caused by bacteria or a virus.

Bacterial pneumonia symptoms usually come on quickly.

  • Productive cough
  • Chest pain
  • Vomiting or diarrhea
  • Decrease in appetite

Early symptoms of viral pneumonia are generally the same as bacterial pneumonia, but respiratory symptoms tend to develop more slowly. The child may start to wheeze and a cough may worsen.

Signs of an ear infection

Infants and toddlers

  • Irritability
  • Inconsolable crying
  • Fever
  • Trouble sleeping
  • Unlike the cute little girl in the picture, tugging on the ear is not always a sign of an ear infection.

Older children and adults

  • Ear pain or earache
  • Fullness in the ear
  • Feeling of general illness
  • Vomiting
  • Diarrhea
  • Hearing loss in the affected ear

Child taking spoonful of medicine

Overuse of antibiotics

It is well-known that antibiotic use in general has grown rapidly in the last several decades. Not only are antibiotics used in medicine, but also in livestock, supposedly to decrease diseases, but also for enhanced weight gain and growth. Excessive use of antibiotics has led to the development of “super bugs,” which are multi-resistant bacteria. These “super bugs” are capable of causing more significant infections that are much more difficult to treat and potentially life threatening. Consequently, over the last decade there has been increased discussion and legislation geared toward limiting the “overuse” of antibiotics.

When pneumonia is caused by bacteria, it needs to be treated with antibiotics. Often, symptoms alone determine whether it’s bacterial or viral, but a sputum culture can confirm the diagnosis. Ear infections can also be caused by a virus or bacteria — the only way to know for sure is to insert a needle into the middle ear space and withdraw fluid for culture. This procedure is often done in research settings, but rarely done in the primary care provider’s office. For years, no matter what the cause, ear infections in children were routinely treated with antibiotics, but the recommendation has changed.

Ear infection treatment guidelines

In 2012, the American Academy of Pediatrics (AAP) published a revision of the 2004 AAP and American Academy of Family Physicians (AAFP) guidelines on the treatment of acute otitis media. The guidelines suggest that most ear infections will begin to resolve within the first 24-72 hours and the only treatment necessary is something to relieve the pain. For children over the age of 2 years, pain relievers include: acetaminophen, ibuprofen, heat, and possibly analgesic drops, as that provides more consistent early relief of discomfort. If the pain is not relieved with analgesia or persists beyond 72 hours, the recommendations suggest that treatment with the appropriate antibiotic may be warranted.

When health care providers follow the AAP/AAFP guidelines for treating ear infections and discuss the guidelines with parents, there is a significant potential to decrease the use of antibiotics in children. This is one step in the pathway to “Choosing Wisely” in health care.

Choosing Wisely

Choosing Wisely® is a national initiative led by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports. Choosing Wisely in Maine is a key initiative of Maine Quality Counts, an independent health care collaborative committed to improving health and health care for the people of Maine. The primary goal of Choosing Wisely is to encourage people to have informed conversations with their doctors/health care providers, including their child’s pediatrician.

What you should be asking your health care provider

Ask your doctor/health care provider these five questions before any medical test or procedure at your next appointment:

  1.  Do I really need this test or procedure? Medical tests help you and your doctor or other health care provider decide how to treat a problem. And medical procedures help to actually treat it.
  2. What are the risks? Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
  3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more.
  4. What happens if I don’t do anything? Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
  5. How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.

How to ask even more questions

Want to ask your doctor/health care provider about that test, diagnosis or treatment? How can you squeeze your questions into what can feel like an already rushed appointment? Get some pointers in the Choosing Wisely videoTalking with Your Doctor.

The more you know, the more prepared you will be to ask your health care provider questions, understand recommendations, and weigh the pros and cons of treatment options, such as whether or not your child needs an antibiotic for that ear infection.

This post was written by:

Lisa D. Ryan, DO
Physician Adviser, Maine Quality Counts

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Diane Atwood

About Diane Atwood

For more than 20 years, Diane was the health reporter on WCSH 6. Before that, a radiation therapist at Maine Medical Center and after, Manager of Marketing/PR at Mercy Hospital. She now hosts and produces the Catching Health podcast and writes the award-winning blog Catching Health with Diane Atwood.