CNN recently reported that the Journal of the American Medical Association published a study that giving a child antibiotics does little to speed a child’s recovery from an ear infection, while raising some risks in side infections (rash, diarrhea, etc.). Breezy Mama turned to one of our favorite go-to pediatricians Dr. Gillin to get the truth about giving kids antibiotics for any illness or infection – are they a necessity or can they be avoided—and the downside to giving them to your child.
What are your thoughts on the study on ear infections and antibiotics?
So previously in 2004, The American Academy of Pediatrics published guidelines on the management of ear infections. An important part of these guidelines was the option of “observation” instead of antibiotics. This recent study again addresses this topic of whether an ear infection requires antibiotics.
Some ear infections are caused by bacteria, but some are caused by viruses. Antibiotics only fight bacteria. Therefore, some ear infections do not need antibiotics.
My personal thought is that some ear infections do require antibiotics, and there are some that we can observe closely. Observation however, does not mean “ignore”. For my patients, I would like to see them back in the office in 2 days to recheck the ears and make sure the infection is not getting worse.
There are several things that guide me as to whether I would prefer to prescribe an antibiotic or not. I prefer to prescribe if my patient is less than 2 years old, has a fever (typically if greater than 101), or if the ears look very bad.
Sometimes an ear may just look a little pink. I would “observe” this patient. However, if I had a screaming 1 year old with a 103 fever and a horrible looking ear, I would prefer to treat this.
Remember when everyone with green snot was prescribed antibiotics? Now we know that it may resolve on its own.
I think we will start having better guidelines as to which patients need it, and which do not.
My third baby has gotten two ear infections and it was unbearable. She screamed and screamed and screamed… the hubby and I aren’t a fan of antibiotics but we are HUGE fans of not having our child in pain (or hearing her scream). I felt the second we started antibiotics, the pain subsided. Or was that just the Tylenol?
Well, it was probably both. We know that some ear infections DO need antibiotics. A screaming baby, especially if the ear looked bad or if she had a fever, probably needed the antibiotics. But it usually takes at least several doses to see a change. (By the way, if your child still has ear pain, or fever after 3 days of antibiotics they should be re-evaluated by their doctor.)
So the Tylenol probably helped at first- until the antibiotics kicked in.
Which reminds me- if they are in pain, do use pain reliever until you can see your doctor, and until the antibiotics start working.
So- big point here….You HAVE to see your doctor. I cannot “see” an ear over the phone! Some patients will want an antibiotic prescription “called in” over the phone- this is not good for the patient. They really need to be seen.
Do antibiotics pose a threat to a child’s immune system because, if given too often and too young, it can kill the “good” bacteria in a child’s body?
Antibiotics kill good bacteria and allow the overgrowth of certain yeasts such as candida. Some doctors will recommend that you take a Probiotic (like the stuff that is in yogurt) that will help maintain good bacterias if taking antibiotics.
Is there an illness when it’s imperative to give a child antibiotics or is there always an alternative, such as pain relief?
So I think for ear infections- the older child, afebrile (having no fever), otherwise healthy child- they may be able to just do pain relief. But some ear infections need antibiotics.
Other infections that absolutely need antibiotics are urinary tract infections, pneumonia, and meningitis (ASAP). These have no alternative and should not wait.
What are the downsides to NOT giving your child antibiotics for an infection or illness?
Other than the obvious of taking longer to get better, there has been the question of actually having the infection spread to cause a more serious infection. So far we have not seen an increase of the complications when treating without antibiotics.
Anything else you’d like to share?
I think that the message here is to see your doctor, and then together decide what the best approach would be for your child. There are so many factors that play a role in making the best decision for each patient.
Some kids have anatomies that make them more prone to ear infections. So if a child starts having many ear infections (more than 3 in 6 months, or 6 in one year), then they should talk to their doctor about seeing an Ear Nose and Throat specialist to consider ear tubes.
Keep up on all the latest PLUS be entered to win a Summer Infant BabyTouch™ Digital Video Monitor ($280 value)! Subscribe to receive the Breezy Mama newsletter email (it’s free!) — Hurry and enter your email address here:
Shakha Gillin, M.D., F.A.A.P. attended UCSD for her undergraduate education and medical school (and if she looks familiar that’s because she’s the twin sister of Breezy go-to dermatoligist Dr. Vi). She practiced pediatrics in La Jolla for 5 years before joining El Camino Pediatrics. She has also worked in private practice in Newport Beach and in the Rady Children’s Hospital Emergency Department. Dr. Shakha Gillin has a special interest in preventative care, particularly healthy and active lifestyles for children. She was recognized by San Diego Magazine as a “Top Doctor” in 2006, 2007, 2008 and 2009. She also organizes the North County Pediatric Journal Club, an every other month meeting where local pediatricians discuss the latest pediatric medical topics.