Tuesday, March 3, 2009

Ear infections-- drugs

Sorry for infrequent blogging, evidently when I say tomorrow, I actually mean next week. I blog at work if not too busy, and lately it's been so busy I don't eat. Trying to blog at home is too much of a headache for me with children, hats off to all of you who accomplish that feat. On to ear infectons.

There are three major organisms that can cause ear infection. We usually start with high dose Amoxicillin for ear infections. Sometimes the bacteria have mechanisms in place to defend against the antibiotics we give. Augmentin, which is usually the next step, is amoxicillin plus a drug to fight the bacteria's defense mechanism. Omnicef, which is often the third choice, is a broad spectrum antibiotic. It's like a big missile that wipes out everything in its path. Amoxicillin is not a weak antibiotic anymore then Omnicef is a strong antibiotic. Amoxicillin is a great drug, but more specific like a precision missile that only wipes out a few buildings instead of a whole block. Any antibiotic can cause diarrhea and these often do. Taking some probiotics like lactobacillus when on antibiotics can help. Usually if your child has not been on any antibiotics for at least 2 months we start with amoxicillin again. The bacteria usually have to be exposed to the drug to be resistant to it. We want to use the antibiotic with the most narrow spectrum to cover the infection, because if we keep giving the broad spectrum drugs and your child's infection become resistant to that drug, there are fewer antibiotic choices left and a higher likelihood that your child could have complications with other resistant bacteria. Some children do seem to be colonized with resistant bacteria for whom amoxicillin no longer is effective, but for the most part always start with amoxicillin, excepting of course those who are penicillin allergic.

Monday, March 2, 2009

Ear infection

Ear infections are a secondary infection that usually occur after an upper respiratory tract infection ( runny nose, congestion and cough). Most often your child has been sick for a bit, starts to get better and then develops fever and stops eating or sleeping much. Fluid that has built up in the Eustachian tube gets secondarily infected. Recently there have been a lot of studies in Europe where they actually tap the infected ear and grow them out and they have found that especially in older children, the vast majority of unilateral ear infection without fever are viral. In the realm of 75-80% of them. In children older then 2 without fever and a one sided ear infection I give the parents a script for an antibiotic and tell them to wait a couple of days to see what happens. I recommend the parents continue to treat their child's pain with Tylenol and ibuprofen and I really like the benzacaine numbing drops. I even do this with my own children. I have looked in their ears and they have bad infection I given them pain meds and send them to bed and then they never complain about it again.

In children less then 2 I treat all infections.
More about ear infections tomorrow.