The Latest on Ear Infections.
What Are the Latest Figures on Otitis Media?
The number of office visits for otitis media increased from 9.9 million in 1975 to 24.5 million in 1990. The latest figures from the CDC put the number at over 30 million visits per year.
Why the Increase?
No one knows why. Some doctors believe the increase in day care attendance is the reason. More skeptical doctors say much of the increase is due to misdiagnosis. Another proposed explanation is that parents, particularly those with HMOs, seek more medical care for their children, thereby increasing the number of diagnoses of otitis media.
Is Amoxicillin Still the Drug of Choice?
Yes. For initial episodes and for repeat episodes that are at least four weeks apart. Less than 10% of children don't improve when treated with amoxicillin.
Is Doubling the Dose Useful?
Sometimes. It depends on the community where the child lives. In some areas, such as Dallas where 20-30% of otitis media is due to highly resistant strains of pneumococci (a bacteria that causes ear infections), doubling the dose may be of benefit. Your doctor should know what's best for your community.
How About Other Injectable Antibiotics?
Rocephin (ceftriaxone) is not for every child, but sometimes it's the most appropriate antibiotic. For example, in children who are vomiting and keeping down the antibiotic is difficult. If the chances of the child getting a full course of antibiotics, one shot may be better. Other reasons for using an injectable antibiotic include a possibility of sepsis (more generalized infection) or if other antibiotics have not worked.
What's the Best Alternative Antibiotic?
There isn't one. There are 13 alternative antibiotics to amoxicillin. All are equally effective. Taste-wise, cefaclor (Ceclor) is considered the more tasty by most children. If cost is a consideration, all except sulfisoxazole/trimethoprim are approximately similar in cost.
"The fact is whatever you (the physician) pick will probably be ok. At least at this point, there's no clear advantage for a single antimicrobial agent for a child who's had amoxicillin recently or failed amoxicillin," Dr. Klein said.
Do All Children Need Treatment with Antibiotics for Acute Otitis Media?
No. Dr. Klein believes a majority don't need any antibiotics. About one fifth of pneumococcal and half of H. influenzae caused otitis media clears with no treatment at all.
Can Doctors Identify Which Children Need Treatment and Which Don't?
No. And that's the problem. The general consensus is that acute otitis media is treatable and that there are no criteria for determining which children would do ok without treatment.
What's the Best Way to Manage the Otitis-Prone Child?
Dr. Klein has a number of non-medicinal suggestions:
* Smaller day care settings
* Avoid exposure to tobacco smoke
* Breast-feed as long as possible
If the problem persists, then chemoprophylaxsis (taking a drug to prevent the occurrence of an illness) is the next step. This approach is still useful. Resistance is an issue, but children on chemoprophylaxsis have fewer episodes of otitis media.
Dr. Klein recommends using half the usual does of amoxicillin for children who have three episodes in six months, four episodes in 12 months, or two episodes in their first year of life if the parents or older siblings had otitis media.
He also recommends influenza vaccination for all children who had otitis media the previous winter. Children over two years old should receive the pneumococcal vaccination.
If these steps don't work, then tympanotomy tubes (ear tubes) may help. If they don't work, then an immune system evaluation should be done.
Family Practice News, 6/15/97, p. 45.