It’s that season again… for ear infections!
Holiday break is over… Parents are back to work, and kids are heading back to school and daycare.
Which can only mean one thing… chances are, your kid(s) will probably have an ear infection this winter/early spring.
Ear infections, also called AOM for Acute Otitis Media, are one of the most common reasons patients see a physician. Ear infections result in about 25 million office visits each year, and physicians write roughly 16 million prescriptions each year to treat AOM.
Around 90% of children will have had at least one episode of AOM by the time they turn 3 years old, with about 1/3 of those children experiencing 3 episodes by the time they turn 3. Additionally, the younger the child is when they experience their first ear infection, the more likely they are to experience more ear infections down the line.
Multiple factors can increase the risk of a child having an ear infection, including attending daycare, exposure to second-hand smoke, lack of breast-feeding as an infant, and abnormal eustachian tube function, resulting in fluid build-up in the inner ear.
Fortunately, there are many steps a parent can take to reduce the risk of their child having an ear infection. This includes breast-feeding the infant for at least 6 months after birth, and avoiding feeding the child in a position where the child is laying down and facing up. Perhaps most importantly, a child’s home should be SMOKE FREE. Also, a vaccine (called PREVNAR 13) is available once the child is 6 weeks old, and it is administered in 4 doses at ages 2, 4, 6, and 12 months. This vaccine will protect the child from the most common bacteria that cause ear infections. Side effects from this vaccine include redness and tenderness at the injection site and irritability. Side effects from the vaccine generally resolve after a short time.
So, how do you know if you or your child has an ear infection?
Signs and symptoms of ear infections include a fever (although it’s not always present), ear pain (which can present as a child tugging at the ear), impaired hearing, decreased appetite, and irritability. In addition to these symptoms, there can be a bulging and discoloration of the ear drum (called the tympanic membrane), resulting from fluid build-up in the inner ear. These signs and symptoms are necessary for the diagnosis of AOM.
The major decision that a physician must make is whether or not to prescribe an antibiotic to the patient because 1/3 of ear infections are caused by viruses, NOT BACTERIA, and 80% of bacterial ear infections spontaneously resolve within 2-3 days. This is important to note because patients taking an antibiotic will likely not experience any relief of their symptoms until 2 or 3 days of antibiotic use, but they will be at an increased risk for side effects like diarrhea when using the antibiotic. Antibiotics will NOT treat viral infections.
If the child is older than 2 years old, does not have a fever, and has mild symptoms, many physicians may choose to follow the “wait and see policy,” which involves monitoring the child’s symptoms until the infection goes away on its own, treating the symptoms (ibuprofen or Tylenol for pain) and making sure the child is adequately hydrated.
If the child is less than 2 years old, however, many physicians will prescribe an antibiotic in order to treat the infection and alleviate the symptoms.
The drug of choice for treating ear infections is amoxicillin (“the pink stuff”), usually given as a flavored liquid. Amoxicillin is usually given 2 to 3 times per day for 7-10 days. In order to prevent the infection from returning, it is very important to finish all of the medication exactly as prescribed. Follow up with the pediatrician if the symptoms get worse.
If the patient is allergic to penicillin – DON’T WORRY. The physician will likely prescribe azithromycin, which is just as effective as amoxicillin.
If the patient’s symptoms get worse or do not improve at all after 2-3 days, the physician may prescribe Augmentin, a slightly stronger formulation of amoxicillin, or azithromycin.
Finally, if the above treatments fail to treat the ear infection, the physician may prescribe Levaquin or Zyvox, which are powerful antibiotics and the last resort for seriously resistant ear infections. Most can be treated simply with Amoxicillin or Azithromycin.
Remember, help prevent the spread of infections by washing your hands regularly, keep your children’s environment smoke free, and avoid situations will seriously ill guests.
-Michael Galbraith Duquesne University PharmD Candidate.
About the author: Michael is an intern with spartan pharmacy, he will be graduating from Duquesne University in 2013. You will most often find him in our kings school road store. Thank you for taking the time to read our blog.
Reasonable effort and care have been taken to prepare this blog, and the information provided is believed to be accurate at the time of posting. However, this information is not intended to constitute and “authoritative statement” under food and drug administration rules and regulations. When in doubt please make sure to contact your pharmacist or physician when making dietary changes, or regarding medical treatment and other related issues. This blog is meant to be informative, Spartan Pharmacy asks that you please use this information as a reference and not a replacement for proper medical treatment. Please, leave that to the professionals!
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