Doctors wary of medicating ear infections

Lucas Madrid was feverish and miserable in January. The 7-month-old pulled at his infected ear and woke up crying night after night. After more than a month and three courses of antibiotics, the Denver boy's ear finally cleared and he perked up, said his mother, Sara Madrid.

The infection returned last week. Lucas Madrid's woes are part of a much bigger problem: Studies show an increasing number of bacterial infections don't respond to antibiotics.

In 1996, for example, the antibiotic erythromycin fought off Staphylococcus aureus, which causes skin and other infections, 71percent of the time. By 2001, the drug was effective in just 46percent of cases.

And when it comes to prescribing antibiotics, ear infections - known as otitis media - have been the main event.

"Ear infections account for at least one-quarter of all antibiotics prescribed in the United States," said Patricia Yoon, a pediatric ear, nose and throat specialist at Children's Hospital in Denver.

Huge impact

"That's a staggering proportion. The impact of otitis media on antibiotic resistance is huge," Yoon said.

And so, as this year's ear infection season winds down, doctors say they're growing reluctant to prescribe antibiotics.

The American Academies of Pediatrics and Family Practice have already changed their guidance, saying it's no longer necessary to give antibiotics at the first sign of a mild fever and swollen eardrum. Still, 80percent to 90percent of all ear infections in the United States are treated immediately with antibiotics, Yoon said.

A third of ear infections by Streptococcus pneumoniae - a common cause of ear infections - in the United States are resistant to at least one antibiotic, Yoon said.

Denver resident Lindsey Gutterman said she understands antibiotic resistance all too well. Her son and daughter both battled antibiotic-resistant infections this winter.

"I can't stand antibiotics, they make me crazy," she said.

All winter long, it seems, Sadie Gutterman, 2, talked about the bugs in her ears, which hurt, Gutterman said.

After three months and five courses of antibiotics, Sadie was still getting dizzy and stumbling around the house, Gutterman said.

She and Sadie's doctor finally decided the drugs might be doing more harm than good.

In February, Sadie got ear tubes - a surgeon inserted tiny tubes through her ear drums, ventilating the middle ear to clear persistent infections.

In the middle of her daughter's plight, Gutterman's son, Ethan, 4, contracted strep throat, which didn't respond to the antibiotic Augmentin. Ethan recovered after a second course of another antibiotic, Gutterman said.

"It was not an easy winter," she said.

Growing resistance

Even with perfect compliance - no missed doses, no spit-up pink syrup - antibiotic use pushes bacteria to develop resistance, said Richard Rosenfeld, a pediatric ear, nose and throat specialist at Long Island College Hospital in New York.

Rosenfeld helped develop the new ear infection recommendations. Studies show many children can fight off ear infections on their own within a few days, Rosenfeld said.

Recent studies also show some ear infections are viral, and viruses do not respond to antibiotics.

Rosenfeld said he and his colleagues increasingly send patients and parents home with a prescription for an antibiotic, but they recommend parents don't fill it for 48 hours - unless kids are in pain or fevers spike above 102degrees Fahrenheit.

Francesco Beuf, a pediatrician at the Pediatric Center in Boulder, Colo., said he has prescribed fewer antibiotics in recent years.

Beuf estimated he now prescribes antibiotics for fewer than half the ear infections he sees - especially when the children are older than2.

"I try to fix them up with a local anesthetic, ear drops, and they usually feel better within minutes," Beuf said.

Dean Prina, a pediatrician with Partners in Pediatrics in Denver, said he has long tried to avoid antibiotics.

"There's no question that there are increasing strains of bacteria that are resistant," Prina said. "And at the same time, new sources of bacterial infection are emerging."

A decade ago, different types of bacteria caused ear infections, Prina said. Prevnar - a childhood vaccination - prevents infections that were once the most common, he said.