Ear Infections: Are there alternative treatments?

Last week, the doctor put my seven month old on antibiotics for an ear infection. I've been told that antibiotics may weaken her immune system, so she would be apt to contract colds and infections more easily. She's in daycare, so she's exposed to other children's illnesses. Is there an alternative to giving an infant antibiotics?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

As simple as your question may seem, alternatives to the treatment of ear infections are loaded with controversy.

On one side, there are physicians who advocate treating all ear infections with antibiotics. Most physicians in the US believe this. Other doctors feel this is over-treatment and believe no treatment aside from pain control is required for most ear infections, at least for the first three days. Many doctors in Europe feel this way.

And there is another segment that is looking to treatments such as herbs, chiropractic manipulation, acupuncture and other forms of alternative medicine. Let me elaborate on each point of view before I give you my opinion.

Treat All Ear Infections With Antibiotics

Ear infections are technically limited to what is called the middle ear. This middle-ear space is confined to the area behind the ear drum, extending to the bone and tissue that separate it from the brain. Before the discovery of the antibiotics used today, children got over their ear infections pretty well. However, a small but substantial percentage of children had infections that worsened, causing destruction of bone surrounding the middle ear. This destruction allowed the bacteria to invade certain bones (mastoiditis) as well as the tissues surrounding the brain (meningitis). There were even children whose infections extended into the brain itself, causing substantial damage. With the onset of the use of antibiotics, these complications all but disappeared. Physicians who advocate the use of antibiotics do so because they feel the risk of serious complications from ear infections, while small, is not outweighed by any benefit of not treating.

Treat Only Those Who Still Have Symptoms After Three Days

We know at least 30 percent of ear infections are caused by viruses. Viruses do not respond to antibiotics, only bacteria do. We also know that up to 85 percent of all ear infections will clear themselves in three to seven days as the body fights off the infection. Physicians who advocate very judicious use of antibiotics do so because studies have shown that the majority of ear infections clear themselves. They also recommend this because to give all children with ear infections antibiotics would be to give antibiotics unnecessarily to almost one-third of these children. With the over-use of antibiotics and the very real problem of bacteria becoming resistant to the antibiotics we currently have, these doctors feel the risks of overuse of antibitotics are much greater than the small risk of complications due to an untreated bacterial ear infection.

Treat with Alternative Medicine

Ear infections are the number one reason children see a doctor. There are children who seem to one get one ear infection after another despite the best medical treatment. And some parents are averse to exposing their children to multiple courses of antibiotics. Many people feel alternatives to traditional medicine have significantly helped their children and have recommended them. These include herbs, dietary supplements, chiropractic manipulation, and others.

To Treat or Not to Treat ... Here's My Opinion

Quite honestly, I tend to ride the fence on this issue. I believe the European doctors are correct when they say the US physicians are too liberal in the use of antibiotics for ear infections. On the other hand, I do not want to go back to the days in which a small but significant number of children had to go to surgery to clear infections that extended into the bone and brain. The difficulty of resistant bacteria is a compelling reason for physicians to be especially careful in selecting whom to treat with antibiotics. Unfortunately, there is no good method to figure out who will get better on his or her own and who will have complications. So for now, I tend to advocate treating almost all ear infections with antibiotics. However, I think the day will soon come (perhaps it is already here) when waiting one to three days to see if the ear infection goes away on its own will be the most prudent course of action.

As for the use of alternative medicine, I generally don't recommend it, simply because no alternative treatment has been shown to be effective. In fact, there have been reports of harm coming to children with some of them. Up to now, the studies looking at their effectiveness have been plagued by poor study design, and when the majority of ear infections clear by themselves anyway, it's hard to prove alternative methods actually work. As further study is done, perhaps other ways of clearing ear infections will be developed. But until then, I feel the use of alternative methods is usually a waste of time and money.

The widespread use of antibiotics for ear infections has never been shown to cause any immune-system dysfunction. However, it is clearly causing difficulty when it comes to resistant bacteria, so your concern about antibiotics is valid. With your daughter in daycare, she will most likely acquire other ear infections. So, if you have serious reservations about using antibiotics, I suggest you discuss with your doctor the option of not treating the next ear infection right away. Returning two to three days later to have her ears checked -- and then starting antibiotics if it hasn't cleared -- may be an option both you and your doctor are comfortable with.

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