This is the most common question I get from friends -- does my kid need antibiotics for their ear infection? To treat... or not to treat?
The bottom line: while ear infections can be viral or bacterial — a child’s immune system will most likely get the job done! This is GOOD NEWS because it is best to save antibiotics for when we really need them.
Studies show that in cases of antibiotic vs. placebo treated ear infections — both will completely resolve similarl. However, the antibiotic group may have 1 day less of symptoms — but at what cost? Also, mitigating ONE day is a very small benefit.
Antibiotics are the top drug for causing ER visits due to adverse reactions— diarrhea, nausea, rash, etc. Common antibiotics, the ones most frequently prescribed and regarded as safest, cause nearly half of emergencies due to antibiotics, according to the CDC. A pediatrician said last week that while an ear infection is stinky to get, the effects of antibiotics will be STINKIER. I agree -- let's avoid that diarrhea if we can!
True! So your child *may* have one less day of ear pain but will likely get an adverse effect like diarrhea. Doesn’t seem like the best swap. All medications will require you to consider a risk/benefit scenario. Fortunately in ear infections, you can rest assured that the risk is not worth the small benefit, unless you and your doctor determine that your child has a severe infection.
But more importantly than diarrhea or a rash -- is the impact on a kid’s gut flora- the microbiome that make up their gut. Your gut is its own ecosystem, providing a home to 100 trillion microorganisms, including 400 different species of bacteria. These microbes in your gut play CRUCIAL roles in digestion, immunity, metabolism, and mental health.
Studies even show that just ONE course of antibiotics can impact gut flora for LIFE. The observation that gut microbiome can be permanently affected even by short-term antibiotic treatment— and that this change can have long-term effects— tells us we should delay unless necessary. Also, scientists are discovering more and more about that gut-brain connection, so we must understand we are impacting a vary complex part of our body that we do not fully even understand!
Another thing to consider: did yu know some doctors prescribe antibiotics to satisfy you but do not believe they are necessarily appropriate? That’s right! You have power in this shared decision. Many doctors believe that you come to see them because you want antibiotics, even if you aren't sure that you want them -- they perceive that you absolutely do, and this impacts prescribing!
If you are concerned about complications of an ear infection, you may consider the “watchful waiting” approach with your doctor. This allows you to check in with your provider as the infection takes its course! Often a provider will let you know actions you can take in the following days to support your child, and a number to call if your child hasn't improved within a certain time frame.
SO the take home message is this: antibiotics don’t help resolve symptoms much sooner and they add a slew of potential problems. It’s best to support your child through the infection — tips on that in my next post on this. I also will go more into gut flora -- this is a very large component of why we do not want to over prescribe antibiotics here. Not to mention antibiotic resistance! . Stay tuned. Remember all these decisions should be made with your trusted health care provider. More to come. Here is some more information on the CDC’s website. And here is a great quick resource from the American Academy of Pediatrics.
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