Antibiotic Resistance and Ear Infections- To Treat or Not to Treat

By Douglas G. Olk, M.D., Department of Pediatrics, Medical Associates Clinic

There was a time when bacterial infections could be treated with just one antibiotic—penicillin. This “miracle drug” was developed in the late 1940’s and used successfully to treat many infections. Over time, however, some bacterial germs developed resistance to this antibiotic. Through mutation and multiplication, they developed the ability to grow, even in the presence of this medication. Using penicillin to treat the resistant germs was no longer possible.

In an effort to “stay ahead” of resistant germs, scientists developed newer and better antibiotics. Many antibiotics we use today were developed for just that reason—to kill resistant germs. Unfortunately, bacteria have kept pace with modern science. Some have developed resistance as fast as new antibiotics can be developed. This is not good. Imagine having an infection with bacteria against which there are no antibiotics.

Fortunately, there are other strategies available to us, including vaccines. Many current childhood vaccines allow us to develop natural immunity against germs. With natural immunity, we are much less likely to get bacterial infections in the first place. A good example is the new Prevnar vaccine that allows children to develop antibodies (germ fighting proteins) against a germ called pneumococcus. Pneumococcus can cause meningitis, pneumonia, blood-borne infection, sinus infection, and ear infection, and it has developed significant antibiotic resistance.

Another more important strategy is to decrease the “overuse of antibiotics” when not needed. If a bacterial germ isn’t exposed to an antibiotic, it is less likely to develop a resistance.

In the past, health care providers were eager to treat ear infections. The thinking was “the sooner we started an antibiotic, the sooner the child would feel better.” Newer studies have shown that many children with ear infections (50-75%) get better on their own without antibiotics. Why? Many ear infections are caused by viruses and/or our own immune system can fight off the infection on its own.

Given this and the growing concern over antibiotic resistance, the American Academy of Pediatrics recently published new guidelines for treating ear infections. In short, older children with less severe infections may not need an antibiotic. In these situations, health care providers offer the option of observing things. If the infection improves, no antibiotic is used. If the infection worsens with more pain or higher fever, an antibiotic would be started. For younger children or those with severe infections, antibiotics would still be offered initially. It is hoped that this strategy will help decrease the overuse of antibiotics.

Talk to your Health Care Provider about these important issues the next time that you are in to their office.