Ear Infections

I was on call last night, and I spoke to a grandmother of a nine year-old who had fever and ear pain.  Her low-grade fever had just begun; the grandmother wanted to know how much Motrin to give.  I discussed the dose and told grandma to give the child lots of fluids, but I also told her that the child would have to be examined before any antibiotics were prescribed.  The grandma understood, which was a relief to me, because at the first twinge of ear pain, some parents think that their child needs an antibiotic immediately. 

On examinatin, thick, cloudy fluid behind the ear drum or a red, bulging drum suggests middle ear infection, or otitis media.  Clearish fluid behind a slightly red ear drum is more suggestive of a concurrent upper respiratory tract infection, most often caused by a virus.  When a child has an examination consistent with a viral etiology, I tell the parent that an antibiotic is not the answer, that watchful waiting is prudent.  Sometimes, depending on the exam, I do give a "safety-net antibiotic prescription," explaining that many ear infections clear on their own, but if the child's symptoms were to worsen, the parent should then fill the antibiotic.  Antibiotics are overused.  Waiting 24 -48 hours to see how a child's symptoms evolve can prevent unnecesary medicine use and halt the development of further resistance to antibiotics.  I've found that just having a prescription reassures the parents, especially since they won't have to bring the child back to the office if the pain worsens.  But in most cases when I give the "safety-net" prescription, I am happy to report that the child doesn't eventually need the medicine.