Disease Proof

Ear Infections, Over-Treated?

“Whether bacterial or not, our children get a routine prescription for an antibiotic at every minor illness,” explains Dr. Fuhrman. And when it comes to ear infections kids are REALLY getting hit with the antibiotic stick. More from Dr. Fuhrman:
In some European countries, antibiotics are used for ear infections only when there is a persistent drainage or persistent pain because these infections resolve on their own more than 85 percent of the time without treatment.1 Studies show that the majority of ear infections are of viral etiology. For example, 75 percent of pediatric ear infections were caused by common respiratory viruses in a microbiological survey.2 Generally speaking, the use of antibiotics should be reserved for serious or life-threatening infections, not conditions that the body is well-equipped to resolve on its own.
Adding fuel to the fire, Laurie Tarkan of The New York Times wants to know, are ear infections too often misdiagnosed and then over-treated? Let’s find out:
One reason why ear infections are so often overdiagnosed is that they can be hard to identify in young children, especially ones in screaming pain. “You’re dealing with a tiny subject, the baby or toddler, where the ear canal is narrow and tends to be occluded with wax, which you must remove to see the eardrum, and doing that can be a harrowing experience,” said Dr. Jack Paradise, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine. Doctors then have to interpret what can be subtle differences between an ear inflamed by crying or fever and a true ear infection. “Many if not most practitioners have difficulty in this area,” Dr. Paradise said…

…In 80 to 90 percent of ear infections, the bacterial infection will clear up on its own. Though these bacteria are not typically harmful in and of themselves, clearing up the infection sooner with antibiotics can hasten pain relief. A trade-off is drug side effects like nausea, upset stomach, diarrhea and even rare, life-threatening allergic reactions. “For every case of ear infection that goes away faster, we may cause between three and seven cases of diarrhea,” Dr. Powers said. “We’ve moved the problem from up North to down South.” The use of antibiotics can also increase a child’s susceptibility to new ear infections.
This easy way out of ear infections does carry serious risks. Dr. Fuhrman talks about how antibiotics can actually lead to more—not fewer—ear infections. Have a look:
The vicious cycle of poor nutrition and the overuse of antibiotics works to place a tremendous disease burden on the future health of our children. We bring our young (improperly fed) children to physicians with their first ear infection. At this point the majority of these infections are viral, not bacterial. Nevertheless whether it's viral, bacterial, fungal, or some mixture, a healthy child has no problem recovering from an ear infection without antibiotics. In the United States almost all these children are routinely given antibiotics. Taking the antibiotic kills off the beneficial bacteria and promotes the colonization of more disease-causing strains, and now the next ear infection has a greater chance of being bacterial, not viral. Viral, bacterial, or a mixed infection, it matters not, because at the next visit your kid gets another antibiotic anyway, starting the cycle of infection after infection, antibiotic dependency, and impaired immune function.
I guess the lesson to be learned here is, don’t mortgage the future for the present—quick-fixes are not without their price tag.
1. Haag M. Essential fatty acids and the brain. Can J Psychiatry 2003;48(3):195-203.

2. Bowman S, Gortmaker S, Ebbeling C, et al. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113(1):112-118.
Trackbacks (0) Links to blogs that reference this article Trackback URL
Comments (3) Read through and enter the discussion with the form at the end
Curious - February 15, 2008 1:52 PM

I think it would be very helpful to expand on this topic more. It is very difficult to not give antibiotics to a say 6 month old or a 12 month old when the pediatrician prescribes them. Since they prescribe out of the fear of it turning into something more serious.

If you decide not to treat it, how do you really know when the child has reached that point when it does become more serious?

I think that expanding this to a very specific case by case basis is helpful and less stressful for those who heed this advice.

For example, there are tests to determine if the infection is viral or bacterial right? What are they and how to ask for them? What if there is drainage? How long should one wait for that to clear up? What if both ears are infected?

Different Age groups have different approaches.

Carissa - February 15, 2008 3:46 PM

I just took my breastfed daughter to the Dr when she was 4 1/2 months old and she had an ear infection and I was told to give her antibiotics. I asked about the above information about not needing anti biotics and the Dr explained to me that this was only for children over 2. I would love more clairificaiton and information if and when this happens again.

Sara - February 16, 2008 10:42 PM

Curious and Carissa- Have you read Diseaseproof Your Child ? pages 52-55.

Dr. Fuhrman's Executive Offices
4 Walter E. Foran Blvd.
Suite 408
Flemington, NJ 08822