There is nothing worse than hearing your child cry in pain with an ear infection and wanting to do everything to help them. Oftentimes that means demanding antibiotics from your nurse practitioner, physician assistant or pediatrician. At the same time, the CDC, American Academy of Pediatrics, the World Health Organization and major news organizations have given considerable attention to concern about antibiotic-resistant bugs, otherwise known as superbugs.
One of the reasons for the evolution of superbugs is because of inappropriate use of antibiotics for common conditions like ear infections. When antibiotics are given to kids with ear pain, yet without a bacterial cause of the ear infection, this increases the likelihood that the next time that a bacteria is exposed to that particular antibiotic it may no longer work, not only for your child but for everyone else.
Take this quiz and test your knowledge about ear infections and treatments.
- How many types of common ear infection exist?
Answer: C — three. There are three main kinds of ear infections. They are called acute otitis media; otitis media with effusion; and otitis externa, otherwise known as swimmer’s ear. Symptoms of acute otitis media include pain, redness of the eardrum, pus in the ear, and fever. Children often pull on the ear; infants and toddlers could be irritable. Antibiotics are often prescribed to kids with acute otitis media but they’re not always necessary. Otitis media with effusion is a buildup of fluid in the middle ear without signs and symptoms of acute infection. This is more common than acute otitis media and may be caused by viral, upper respiratory infections, allergies or exposures to irritants such as cigarette smoke. The buildup of fluid in the middle ear does not usually cause pain and almost always goes away on its own. Otitis externa, more commonly known as swimmer’s ear, is the infection of the outer ear canal. It causes the ear to itch, become red and swollen so that touching or pressure on the ear is very painful. There may also be pus that drains from the ear.
- True or False: All ear pain and conditions need to be treated with antibiotics.
Although common causes of acute otitis media are typically bacterial, there are some viruses can cause this condition, too. Virally-caused ear infections will not respond to antibiotics.
- Symptoms that should prompt you to see your doctor for ear infections include:
- A temperature higher than 100.4 F
- Discharge of blood or pus from the ear
- Prior diagnosis or recurrence of ear infections
- Symptoms do not improve or worsen.
- If your child is younger than three months of age and has a fever
- All of the above
Answer: F -All of the reasons above are appropriate reasons to see your doctor for help for an ear infection.
- Antibiotics are NOT appropriate for ear infection if:
- Caused by a virus
- Symptoms are improving
- There is fluid buildup behind the eardrum but no other symptoms
- The diagnosis of ear infection is uncertain
- All of the above
Answer: E- All of the above. In all of the situations above, antibiotics are not needed in the treatment of earaches.
- Which of the following are appropriate home remedies for ear infection?
- Get plenty of rest
- Avoid smoking and/or secondhand smoke
- Use a warm, moist cloth over the ear that hurts
- Take acetaminophen, ibuprofen or naproxen bur check with your doctor
- All of the above
Answer: E- All of the above. All of the treatments above are appropriate home remedies.
- True or False: Doctors are more likely to prescribe an antibiotic if pressured by parents as opposed to no pressure by the parent.
Answer: True — One 1999 study found that 62% of antibiotics were prescribed if a parent expects them from the physician regardless of whether they are needed; however, only 7% are prescribed by a physician if there is no pressure from the parent.
- True or False: Latinos are likely to insist on antibiotics for earaches or ear infections regardless of cause.
Answer: True — In one South Carolina study, 19.2% of Latinos had acquired antibiotics in the United States without any prescription, from friends or relatives. The rationale for this is that many countries do not regulate antibiotics which has influenced use by making antibiotics seem like simple over the counter drugs.
- For your doctor to diagnose a bacterial ear infection, which criterion needs to be present?
A) History of sudden onset of signs and symptoms
B) Presence of middle ear fluid or fluid behind eardrum
C) Signs or symptoms of middle ear inflammation—redness or fever higher than 100.4F
D) All of the above
Answer: D- All of the above. All three criteria are needed to make a diagnosis.
0-3 correct — Hit the books and review these links
http://www.cdc.gov/media/releases/2012/dpk-antibiotics-week.html http://www.cdc.gov/getsmart/campaign-materials/week/downloads/gsw-factsheet-parents.pdf http://pediatrics.aappublications.org/content/125/2/384.full
4-6 correct — You have been doing your homework but need a little more reading
7-8 correct — You are ready for medical school
Dr. Joseph Sirven is a first-generation Cuban-American. He is Professor and Chairman of the Department of Neurology and was past Director of Education for Mayo Clinic Arizona. He is editor-in-chief of epilepsy.com and has served U.S. and global governmental agencies including the Institute of Medicine, NASA, FAA, NIH and CDC.