The Right Way to Treat an Ear Infection

Ever wonder what goes into the decision to prescribe antibiotics? A pediatrician and mom explains all the factors to consider before deciding on the best treatment.

When to Worry: Ear Infections

Mom holding baby

When you have a child with an earache, you want to make it go away. Now. Completely.

Ear infections are the second most common illness of childhood behind colds, which means that nearly all of us have shown up at the doctor's office with a cranky child who is holding his ear(s). I've actually been there on both sides: as a mom raising five kids and as a pediatrician.

It's natural to expect a prescription for an antibiotic. After all, your child has an infection, right? But it doesn't always work that way. Doctors today are less likely to pull out that prescription pad, because the germs that cause ear infections (and other infections) are becoming resistant to antibiotics. It's important to understand these points.

Not every earache is an infection.
The congestion of a cold can make a child's ears feel clogged and painful, but that's not necessarily an ear infection. Sometimes ear pain can actually be pain from a tooth problem, for example. (Teething doesn't cause ear infections, but it can lead to earaches.)

Bacteria aren't always to blame.
Some infections are caused by viruses, like the germs that are responsible for colds. While a higher fever and an inflamed eardrum are more likely to indicate that bacteria are causing a child's pain, it's not always easy for us doctors to tell the difference. (And even if there isn't a fever, a child could still have an ear infection.)

Not all ear infections need antibiotics to get better.
Turns out that even if it is caused by bacteria, an ear infection can go away by itself. In fact, more than half of kids will start to feel better in a day with or without antibiotics, and in a week that number goes up to three-quarters.

But as a parent of a kid with an earache, you don't want to wait, especially if it means missing days of school and/or work. If there's a chance that the wonderful Pink Medicine (that's what many of my patients and their families call amoxicillin, the antibiotic recommended for ear infections) will make your child feel better quickly, that's what you want.

I totally get that, as a mom and a doctor. However, there are two real problems with giving out the Pink Medicine for every ear infection: side effects and antibiotic-resistance.

Antibiotics can cause stomachaches, vomiting, diarrhea, rashes, and sometimes allergic reactions or more serious problems. While major side effects are rare, stomach upset isn't; one in ten kids taking antibiotics ends up with diarrhea. We can justify that with illnesses that are contagious, or if the treatment is really necessary—but it's a shame for a child to get diarrhea when her earache would've gotten better by itself in a couple of days.

It's the antibiotic-resistance that has us doctors worried. Bacteria want to survive, just like any other living thing. As they get exposed to antibiotics, they adapt and change over time so that the drugs become less effective. And as the weaker strains of bacteria get killed off by antibiotics, the stronger ones multiply and spread. This is exactly the public-health problem we're seeing as a result of our overuse of antibiotics: strains of bacteria that defy any treatment.

To help pediatricians decide when to use antibiotics, the American Academy of Pediatrics came out with guidelines. This is what your doctor is supposed to do when faced with a cranky child who has ear pain.

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