Ear Aches and Antibiotics: How Providers Decide what to Prescribe
Antibiotic resistance is a real concern in the medical community with researchers diligently working to develop new drugs but also looking at ways to reduce use of the antibiotics we already have. One such study was published last week in the New England Journal of Medicine. Researchers in Pennsylvania and Kentucky looked at whether a shorter course of antibiotics for acute otitis media (AOM or ear infections) in children would be as effective as the typical 10 day course. Unfortunately, they found that the shorter 5 day course did not work as well at clearing the infections.
If we aren’t able to impact antibiotic resistance with a shorter duration of antibiotics for AOM, what can we do? Well, there are some things that physicians can do and some things that patients and families can do. Let’s talk more about both as it is important for patients to understand what factors physicians are considering before starting children on antibiotics for AOM.
To make the diagnosis of AOM, physicians are taking into consideration:
The patient’s history:
- Do they have ear pain? If yes, for how long?
- If too young to say they have pain, are they more fussy than usual? Pulling on their ears? Not eating or sleeping well?
- Do they have a fever?
- Did they have a recent cold or other illness?
- Have they been treated for AOM before? If yes, when and with which antibiotic?
The patient’s findings on exam:
- How do they look in general?
- Does the outer ear look normal? Does it hurt to be moved?
- Does the ear canal look normal?
- What does the tympanic membrane (ear drum) look like? Is it pearly gray or is it red, inflamed and bulging? Is it draining any fluid?
- Is there fluid visible behind the tympanic membrane? If yes, is it clear, yellow, or cloudy?
- Some doctors might even puff a little air into the ear to see if the tympanic membrane moves or not.
If the doctor determines that the patient meets criteria for AOM, it is very reasonable for them to prescribe antibiotics. After discussion with the patient and family, a period of “watchful waiting” could be done to see if the infection clears on its’ own and only start antibiotics if that is unsuccessful. If the ear exam is normal or there is fluid in the ears that is not infected, then antibiotics will not help and should not be prescribed.
What can patients and families do?
- Understand that antibiotics do not help with every illness as many illnesses are caused by viruses.
- If you are prescribed a course of antibiotics for an infection, take the entire course exactly as prescribed, even if you are feeling better.
- Do not take antibiotics that were prescribed for another person or for a different illness.
- Call your doctor if you are not starting to feel better a few days into your treatment.
- Prevent the spread of infection through good hand washing and receiving all recommended vaccinations.
Let’s work together to prevent further antibiotic resistance!