A recent article in the Journal of the American Medical Assocation promotes a new “wait-and-see-prescription” method for treatment of middle ear infections. Also known as Otitis Media, middle ear infections are the most common diagnosis for which antibiotics are prescribed for children. In recent years, questions have been posed as to the effectiveness of prescription medications for this disorder.

Otitis Media refers to inflammation in the middle ear. This is exactly what happens, a collection of fluid gets trapped between our ear drum and the canal which connects our ear to the back of our throat, known as the Eustachian tube. No where in the definition does it define otitis media as an infection. At birth, almost all of our body parts are smaller than that of a full grown human. The Eustachian tube may be an exception to this rule. Many people believe that this canal is at its full length by a young age, and as our head grows into its full size, this tube can often get kinked up. If this happens, then fluid may collect in the middle ear as it is not drained to the back of the throat. If this is the case, a more appropriate treatment may be to try and “pressurize” the Eustachian tube, similar to what we do when we fly in a plane, to help release the fluid and excessive pressure.

The American Academy of Pediatrics and the American Academy of Family Physicians released new guidelines in 2004 for treating different types of otitis media. They reported that 90% of children will experience some form of otitis media before school age. They also commented that the mechanism for this disorder can be as simple as poor Eustachian tube function, or it can be as severe as an infection. The most recent study on this subject reports great results with the wait-and-see-prescription. This new idea is simple, parents are given a prescription for antibiotics, and they are asked “not to fill the prescription unless the child either is not better or is worse in 48 hours.” The original study conducted at Yale University School of Medicine, found that 62% of parents did not have to fill the prescription, and even without the medications, there was no greater risk of fever, increased ear pain, or unscheduled visits back to the doctor. The parents were given ibuprofen and pain relieving drops for their children’s ear, which were to be used as needed to tolerate the pain.

This research is great news in the fight against “superbugs.” With the advent of antibiotics, we are starting to see bacteria that can mutate themselves so they are resistant to antibiotics. This is one reason why they continue to make new antibiotics. The best example is the recent E. Coli infestation in our nation’s spinach supply. When I first heard that E. Coli was found in spinach, I didn’t think anything of it, because many antibiotics will kill E.Coli. Unfortunately, it was a newer strain that is quite resistant to most of our current antibiotics.

We need to make sure that this does not become a problem with ear infections. When a true infection sets in, we need to be assured that there will be antibiotics that can kill off the bacteria. With new guidelines and protocols for common problems like Otitis Media, we should be able to decrease the amount of over-prescribed medications and therefore slow the spread of superbugs. If your child starts to develop an ear ache, be sure to check with your pediatrician, and see if your child is a candidate for the “wait-and-see-prescription.”

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