Ear Infections - Medication, Natural Medicine |
DEAR DR.PAUL:
My 3 year old son keeps getting ear infections and seems to always be on antibiotics .I have heard that in Europe antibiotics are not used to treat ear infections in children. Am I giving my child antibiotics for nothing?
PEDIATRICIAN DR.PAUL Answers:
Thank you for the question which is shared by many parents as it brings up a very important issue. Firstly, you are not alone, more than 70% of all children will get a middle ear infection, or Otitis Media by the age of 6 years.
The use of antibiotics to treat ear infections has been questioned recently by those who argue that some ear infections, like colds, are caused by viruses rather than bacteria. Antibiotics are not effective in treating viruses, and many people are justifiably concerned about the overuse of antibiotics. But in the case of Otitis Media, it's often impossible to determine whether the infection is caused by a virus or a bacteria, or whether the infection will heal without the use of antibiotics. Additionally it is impossible to know which bacteria is causing the infection ,as different bacteria have different rates of resolving or going away on their own. However, studies have shown that overall, roughly 30% of all middle ear infections do not heal on their own without the use of antibiotic treatment. This means that about 70% of infections go away on their own. The difficulty is, that it is impossible, just by examining the ear, to identify the 30% of children who will need the antibiotics. Identifying these children is important, as untreated Otitis Media has the potential to develop serious infectious complications if bacteria from the infection spreads to other areas of the body, including meningitis. Knowing full well that the majority of ear infections will heal on their own, it is because of these serious risks that antibiotic treatment is still strongly recommended for children with Otitis Media. Since antibiotics were introduced in the treatment of Otitis Media, complications of the infection have dropped dramatically, and are now considered rare.
Today, in certain situations, such as an older child with a mild infection, some physicians may choose not to treat the Otitis Media right away with antibiotics, but may rather follow the child closely making sure that the infection clears on its own. On the other hand, the infection may be very severe and especially in the younger child, an antibiotic is prescribed. Which treatment approach a physician may select depends entirely on the individual situation. Under these circumstances I do not think a child with a confirmed middle ear infection is receiving antibiotics for nothing.
DEAR DR.PAUL:
Both of our children suffer from recurrent allergies and ear infections and we seem to always be taking them to the doctor who usually prescribes antibiotics and other medications. We have been hearing about all these natural remedies such as herbs and homeopathy. Will these help our children's' problem?
PEDIATRICIAN DR.PAUL Answers:
This is a very common question, and unfortunately there are very few studies that may help answer this question. Firstly, it is important to know that most of the so-called "alternative therapies" do not go through the rigorous process of testing of prescription and mainstream medications. Government bodies have strict expectations before allowing a medication to be used. These have to do with two issues: whether the medications are safe and whether they are effective. Determining whether a remedy actually works is tricky. Many patients respond favorably to any intervention ? This is called the "placebo effect." To account for this, scientists must compare the effects of a medication on a person against the effects of "placebo" or a sugar pill containing no active medication. In "double blind"clinical studies, test subjects are divided into two groups, one on placebo, and one on the test medication. Both the physicians doing the evaluation, and the test patients, do not know which patient is taking what. In this way there are no biases. Medications are usually released based on adult data, then further studies are done on children, before the medications are released for pediatric use. Once a remedy is released or use, there is a strict monitoring or surveillance program that records, and if necessary, reacts to any problems that arise. In this way, the public can be assured that the medications we give to our loved little ones are as safe and effective as possible. Natural or alternative preparations do not go through this process and are often recommended by individuals who do not have a medical degree or license to practice medicine. Additionally, herbal medicines, for example, are not subject to the same quality control (but should be) as the standard medications. Consequently, we cannot be sure of their quality, caliber, safety or authenticity. Also, the term "natural" does not necessarily mean safe or non-toxic; Naturally occurring mushrooms for instance, are said to have medicinal qualities, but we know that some are extremely poisonous and should not be eaten. There is no question that some of our most important medications, such as penicillin and digitalis come from "nature," from molds and plants; I have no doubt that some of the "natural remedies" that are used today may indeed contain very safe and effective ingredients and I am happy to see that university centres are starting to study these compounds. I know that certain herbs contain naturally occurring steroids, which may explain why they might potentially work in an asthmatic, for example. I am the first to promote a natural lifestyle including eating well, sleeping enough, and a holistic approach to health including the mind as well as the body, exercise and the avoidance of chemical additives to food and other substances in our environment. However, at this point, I feel that it is too early to support the use of herbal, alternative or homeopathic medicines in children. If, and when, studies prove both their safety and effectiveness, I will welcome them as part of our accepted treatment options in pediatrics. But not before.
This article first appeared on July 28, 2000
