From pulling or scratching at the ears, to crying, fever and hearing problems, most — if not all — parents have lost at least a night’s sleep when their child has a middle ear infection. One of the most common infections in children ages 3 months to 3 years old, acute otitis media (an infection or inflammation of the middle ear) is now the number one cause for doctor visits, accounting for about 30 million trips to the pediatrician each year. New research shows that the country’s already high rates of ear infections among children are increasing. Alarmingly, so, too, are the rates of antibiotic resistance, a condition that occurs when the bacteria that cause an infection are not all killed by antibiotics. As a result, the remaining bacteria mutate, making themselves resistant to that particular antibiotic if and when it’s used again. That’s why area pediatricians are excited about new data which shows that, for children with bacterial acute otitis media, the antibiotic Augmentin ES (amoxicillin/clavulanate) eradicates nearly 40 percent more bacteria than Zithromax (azithromycin), another commonly used antibiotic. When an antibiotic is indicated, “It makes sense to use one that is going to work and to work against the resistant bacteria that tends to occur in children under 2 years of age, children attending day care, and children who for any reason have been on antibiotics within the last two months, including recurrent ear infections,” says Sunil K. Sood, M.D., chief of pediatric infectious disease at Schneider Children’s Hospital at North Shore Hospital in New Hyde Park, and an associate professor of pediatrics at the Albert Einstein College of Medicine in the Bronx. It seems that that antibiotic is Augmentin ES-600. In a study presented earlier this year at the 43rd annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Chicago, 91 percent of the children treated with Augmentin ES showed improvements or were cured, versus 81 percent with Zithromax. Researchers administered Augmentin ES-600 twice a day for 10 days, and Zithromax for five days to 731 children ages 6-30 months with acute otitis media. The study showed that the bacteria that cause ear infections were eradicated from 94 percent of children during treatment with Augmentin ES-600, compared with 65 percent of children treated with Zithromax. In recent years, the most common bacteria that cause the respiratory illnesses that often precede bouts of acute otitis media — Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis — have all become increasingly resistant to antibiotics. Specifically, data from the Centers for Disease Control and Prevention in Atlanta show that S. pneumoniae resistance to penicillin has jumped by more than 300 percent over the past five years. Significantly, a 37 percent difference in favor of Augmentin ES-600 was also shown in eradicating penicillin-resistant S. pneumoniae. According to the study, S. pneumoniae and Haemophilus influenzae, the two most common pathogens, were eradicated in 96 percent and 90 percent of children on Augmentin ES-600, respectively, versus only 80 percent and 49 percent, respectively, of those on Zithromax — a more than 40 percent difference in Haemophilus influenzae coverage. “In general, children with upper respiratory infections that last for several days and are not improving, and suddenly get worse, may be candidates for antibiotics,” says the study’s author, Alejandro Hoberman, M.D., chief of the division of general academic pediatrics at Children’s Hospital of Pittsburgh. “Choosing the most effective antibiotic is the best way to kill all the bacteria and get your child feeling better,” Dr. Hoberman says. The best bet, he adds, is preventing infections from occurring in the first place. “It’s a good idea to get the pneumonococal conjugate vaccine, which targets the bug thought to cause most — but not all — ear infections caused by S. pneumoniae. And since the flu often results in an ear infection, the flu shot, too, is a good call,” Dr. Hoberman says. “But neither of these vaccines were developed specifically for acute otitis media; so while they do help, more protection is needed.” Smoke is also shown to increase the risk of middle ear infections, he says, urging parents to keep their children away from secondhand smoke.
Ear infections on the rise In the September issue of Pediatrics, the journal of the American Academy of Pediatrics, researchers from the University of Rochester found that the percentage of children who developed ear infections before their first birthday increased from 41 percent to 46 percent from the 1980s through 1994. The data suggest that 561,000 more kids across the U.S. got an ear infection from 1991 to 1994 than in 1988 to 1991, and the percentage of kids who got three or more infections by age 6 increased from 35 percent to 41 percent. “We don’t know for sure why we are seeing a sudden jump in acute otitis media numbers as well as resistant bacteria especially resistant S. pneumoniae,” Dr. Sood says. “It started at the turn of the last decade when more women started working and more kids started presumably going to day care. Kids get sicker in day care, and some illnesses may lead to secondary bacterial infections,” Dr. Sood explains. “It’s indirect, but logically it makes sense.”
Don’t beg for antibiotics Studies show that cases of acute otitis media in young children will usually resolve themselves without antibiotics. Yet pediatricians report that many parents in the U.S. insist on antibiotics for children with ear infections. In another recent study, researchers from Children’s Hospital Medical Center in Cincinnati gave the parents of almost 200 children with ear infections prescriptions for antibiotics. But they asked the parents to wait 48 hours before filling the prescriptions, and use pain medication such as ibuprofen alone to treat the infections. Only 31 percent of the parents contacted for follow-up had filled the prescription. The rest of the parents reported improvement in their child’s condition.
“The main message for parents is to understand that most ear infections actually get better on their own because many of them are purely viral. So don’t demand an antibiotic every time your kid has an earache or fever,” Dr. Sood urges. Sometimes, Dr. Sood points out, desperate parents may take their ailing child to the emergency room or other 24-hour care center when his or her ear pain gets bad after hours. As a result, they may get an unnecessary antibiotic prescription from someone who is not skilled at diagnosing bacterial acute otitis media. “If the pediatrician sees you and your child the next day and doubts the diagnosis from the previous night, and says to stop taking the antibiotics, stop them,” he says.
The good news After decades of increase, the unnecessary use of antibiotics now appears to be declining. Researchers from Harvard University School of Medicine in Boston and elsewhere have found that while ear infections continue to account for the majority of antibiotic use in children, decreased diagnosis and treatment of these infections contributed to the lower rates of antibiotics prescribed overall. This information is being hailed as a sign of increased patient and physician awareness of the dangers of antibiotic overuse. To that end, the government has launched a new campaign to cut unnecessary antibiotic use and encourage proper use of medications. The campaign urges consumers to: • Talk with your health-care provider about antibiotic resistance. • Ask whether an antibiotic is likely to be beneficial for your illness. • Ask what else you can do to feel better sooner. • Do not take an antibiotic for a viral infection such as a cold or the flu. Antibiotics cannot kill viruses.
