Antibiotics Not Helping Ear Infection

Check If It’s An Ear Infection

The symptoms of an ear infection usually start quickly and include:

• discharge running out of the ear
• a feeling of pressure or fullness inside the ear
• itching and irritation in and around the ear
• scaly skin in and around the ear

Young children and babies with an ear infection may also:

• rub or pull their ear
• not react to some sounds
• be irritable or restless
• be off their food
• keep losing their balance

Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.

Whats The Difference Between Antibiotic Solutions And Suspensions

Solutions are liquids where the active ingredients are dissolved. Suspensions are liquids in which the particles are suspended, or scattered throughout the liquid, and not quite dissolved. Some medications are stable as a suspension but not as a solution.

The main difference between the two is how irritating they might be. Antibiotic solutions are generally more irritating than suspensions because solutions have a more acidic pH of 3-4, whereas suspensions have a less acidic pH of 5.

Solutions may also contain alcohol to help kill bacteria, but the alcohol can be extremely irritating when these solutions are applied.

Do Ear Infections Always Need To Be Treated With Antibiotics

Many parents bring their children with ear infections to Express Care, Urgent Care and even the Emergency Department to request antibiotics. But, sometimes, antibiotics arent the right choice. Most ear infections cure themselves without the help of antibiotics.

“An ear infection is a bacterial or viral infection that affects the ear. It becomes painful when buildups of fluid and inflammation occur in the air-filled space behind the eardrum,” says Leanna Munoz, Mayo Clinic Health System nurse practitioner. “Signs and symptoms of infection often quickly show.”

Munoz says a great way to tell if your child has an ear infection is if he or she starts showing the following symptoms:

• Pain in the ear, especially while lying down
• Pulling or tugging the ear
• Difficulty sleeping
• Difficulty hearing or responding to sounds
• Fever or headache

Generally, an ear infection will improve within the first couple days and clear up within one to two weeks without any treatment. It is recommended to use the wait-and-see approach for:

• Children age 6 to 23 months with mild inner-ear pain in one ear for less than 48 hours and a temperature less than 102.2 F
• Children age 2 and older with mild inner-ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F

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When To Seek Treatment

If you are having ear pain, you may want to wait a day or two to see if the pain will go away on its own. Often earaches will get better after a few days without any medical intervention.

Some ways to treat the pain in your own home include:

• Pain relievers such as acetaminophen or ibuprofen
• Warm compress on the infected ear

If you are still having pain after a few days, have developed a fever, or if the pain has gotten worse, then you will need to see a medical professional.

Otitis Media In Adults

Otitis media is another name for a middle ear infection. It means an infection behind your eardrum. This kind of ear infection can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection.

Middle ear infections are common in children, but they can also happen in adults. An ear infection in an adult may mean a more serious problem than in a child. So you may need additional tests. If you have an ear infection, you should see your healthcare provider for treatment. If they happen repeatedly, you should see an otolaryngologist or an otologist .

What are the types of middle ear infections?

Infections can affect the middle ear in several ways. They are:

Who is more likely to get a middle ear infection?

You are more likely to get an ear infection if you:

• Smoke or are around someone who smokes
• Have seasonal or year-round allergy symptoms
• Have a cold or other upper respiratory infection

What causes a middle ear infection?

The middle ear connects to the throat by a canal called the eustachian tube. This tube helps even out the pressure between the outer ear and the inner ear. A cold or allergy can irritate the tube or cause the area around it to swell. This can keep fluid from draining from the middle ear. The fluid builds up behind the eardrum. Bacteria and viruses can grow in this fluid. The bacteria and viruses cause the middle ear infection.

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What You Can Do To Soothe A Cold Or Ear Infection:

• Use acetaminophen or ibuprofen to reduce fever and head pressure.
• Try a cool-mist humidifier or shower steam to loosen congestion.
• Try over-the-counter saline drops to clear the nose.
• Consider sinus rinses or devices to remove mucus from young childrens noses.
• For children older than age 1, honey in warm water can soothe a cough.
• For older children, an extra pillow under their head can help them sleep better.

How Can I Prevent Ear Infections

The CDC offers several tips for reducing the risk factors that contribute to ear infections. These include:

• Staying up to date on childhood vaccines including the pneumococcal vaccine that helps protect against the Streptococcus pneumoniae bacteria that can cause ear infections and the flu vaccine.
• Frequent handwashing by parents and caregivers
• Breastfeeding until at least 6 months passes on moms immunity to babies
• Avoid exposing your child to secondhand smoke

Babys first sick visit: its never fun, sometimes scary and often related to an ear infection. But dont worry if your pediatrician sends you home empty-handed at first. At Loudoun Pediatric Associates, well make sure your child gets what she needs in the case of an ear infection, whether its a round of antibiotics or a few days of rest and watchful waiting. Sometimes we need an antibiotic to give those germs the boot, but in other cases rest, fluids and lots of snuggles are the best prescription.

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• Lansdowne

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How Middle Ear Infections Are Treated

Most ear infections clear up within three to five days and don’t need any specific treatment. If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.

Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.

Antibiotics aren’t routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.

Read more about treating middle ear infections

Combatting The Myth Of Amoxicillin Immunity

A major complication of amoxicillin failure is that it convinces many parents that “amoxicillin doesn’t work for my child anymore.” Once a patient has failed to respond to amoxicillin therapy, it is tempting to label that patient “amoxicillin unresponsive” and to exclude amoxicillin from the armamentarium available for future episodes of AOM. However, as reviewed above, it is inappropriate to attribute all episodes of amoxicillin-unresponsive AOM to resistance. In most cases, the bacteria isolated from these patients are sensitive to amoxicillin. The impact of initial antibiotic choice on outcome is minimal. One population-based study found a 12% to 13% rate of antibiotic failure as measured by a prescription for a second course of antibiotics within three weeks.35 The failure rate was similar regardless of the agent first prescribed, but the cost of the prescription was five- to 20-fold higher for the second-line agent. So, despite occasional failure, amoxicillin should remain the first choice for pediatric patients with AOM.

Patients with recurrent AOM might benefit from influenza and pneumococcal immunization, and their parents may respond to a discussion of risk factors such as cigarette smoke, pacifiers, and group day care. Most parents are more willing to accept a watchful approach to AOM therapy once they understand the risks that “antibiotic roulette” poses to a child in day care.

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Ear Infections And Kids Anatomy

Its their anatomy that makes them particularly susceptible.

Older children and adults have a more efficient system for clearing colds. The fluid that builds up in the ear during and after an upper respiratory illness drains down the Eustachian tube, the canal that links the ear to the nose and throat.

In children younger than age 7, the Eustachian tube is shorter and more horizontally positioned, so the fluid takes longer to drain. The build-up can press on the eardrum, causing pain that is especially noticeable to kids when they lay down, breastfeed or suck on a bottle.

Where Is The Middle Ear

The middle ear is behind the eardrum and is also home to the delicate bones that aid in hearing. These bones are the hammer , anvil and stirrup . To provide the bigger picture, lets look at the whole structure and function of the ear:

The ear structure and function

There are three main parts of the ear: outer, middle and inner.

• The outer ear is the outside external ear flap and the ear canal .
• The middle ear is the air-filled space between the eardrum and the inner ear. The middle ear houses the delicate bones that transmit sound vibrations from the eardrum to the inner ear. This is where ear infections occur.
• The inner ear contains the snail-shaped labyrinth that converts sound vibrations received from the middle ear to electrical signals. The auditory nerve carries these signals to the brain.

Other nearby parts

• The eustachian tube regulates air pressure within the middle ear, connecting it to the upper part of the throat.
• Adenoids are small pads of tissue above the throat and behind the nose and near the eustachian tubes. Adenoids help fight infection caused by bacteria that enters through the mouth.

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When Antibiotics Are Used

Antibiotics are typically only prescribed for AOM.

OME and COME occur after an infection has already occurred. Antibiotics cant treat fluid buildup if theres no active infection.

An antibiotic may be prescribed for an active ear infection once your doctor has examined your ear and has determined you exhibit signs and symptoms of AOM or swimmers ear.

Frequent or recurring ear infections should also be addressed with a doctor. Due to concerns with antibiotic resistance, recurring ear infections or COME shouldnt always be treated with antibiotics.

Depending on the severity of your ear infection, your doctor may hold off on prescribing antibiotics.

Will It Happen Again And Can It Be Prevented

Most children have at least two bouts of ear infection before they are 5 years old. These are caused by common viral infections which circulate in the general population and against which your child is not immune. There is generally nothing you can do to prevent the infection from occurring. However, there is some evidence to suggest that an ear infection is less likely to develop:

• In breastfed children.
• In children who live in a smoke-free home.
• In babies and young children who do not use dummies. However, research studies have shown that the use of a dummy in young babies when getting off to sleep can reduce the risk of cot death. So, consider using a dummy in babies up to 6-12 months old at the start of each episode of sleep. But note:
• Do not force a dummy on a baby who does not want one. If the dummy falls out when a baby is asleep, just leave it out.
• Never coat a dummy with anything such as sugar.
• Clean and replace dummies regularly.
• It is best to use a dummy only to help a baby get to sleep.
• Consider stopping dummy use at around 6-12 months old.

Occasionally, some children have recurring bouts of ear infections close together. If this occurs, a specialist may advise a long course of antibiotics to prevent further bouts from occurring.

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Million Ear Infection Prescriptions

Ear infections are the most common reason for antibiotic use among U.S. children, with 15 million prescriptions written annually.

Antibiotic resistance is a growing worldwide public health concern that has been spurred by the widespread overuse of the drugs.

In this country, 96% to 98% of physicians treat ear infections immediately with antibiotics, even though most cases will resolve on their own without treatment, David M. Spiro, MD, MPH, tells WebMD.

Spiro and colleagues from Yale and Vanderbilt University conducted their study to determine if parents would accept a wait-and-see prescription approach to antibiotic treatment when their children had ear infections, and whether the approach would reduce antibiotic use.

The study included 283 children between the ages of 6 months and 12 years with ear infections treated at an urban hospital emergency department.

Children were not included in the study if they had another infection such as pneumoniapneumonia, were severely ill from the ear infection, were hospitalized, had ear tubes or a ruptured ear drum, or had received antibiotics within the prior week.

Roughly half the studied children received prescriptions for antibiotics with no special instructions.

The other half also received prescriptions, but parents were asked not to fill them unless the child was either not better, or worse after 48 hours.

What Is An Ear Infection

There are different types of ear infections. Middle ear infection is an infection in the middle ear.

Another condition that affects the middle ear is called otitis media with effusion. It occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain, or pus build-up in the middle ear.

When the outer ear canal is infected, the condition is called swimmers ear, which is different from a middle ear infection. For more information, visit Swimmers Ear .

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Symptoms Of Chronic Ear Infections

Someone with a chronic ear infection does not usually have any visible symptoms. However, long-term OME can cause hearing problems and other difficulties, particularly in children. These include:

• delayed responses, or taking a long time to understand speech
• difficulties speaking or reading
• less ability to work independently

Doctors consider OME to be chronic if it lasts for or more.

According to a 2016 guideline, OME usually disappears by itself within 3 months.

They also report that 3040 percent of children experience OME more than once, and 510 percent of episodes last for 1 year or longer.

When someone has CSOM, they have a hole in their eardrum. When the eardrum bursts, it releases tension, so not everyone with CSOM will feel . However, people with AOM or recurrent AOM will likely experience pain.

The symptoms of CSOM include:

• leaking fluid from the ear
• a hole in the eardrum

People with CSOM are unlikely to have a fever.

Chronic ear infections develop from a long-lasting or recurrent acute ear infection. Preventing acute ear infections can help prevent chronic ear infection.

Acute ear infections happen when the eustachian tube, a tube that runs from the middle ear to the back of the throat, becomes clogged.

Children are more likely to be affected by ear infections because these tubes are shorter and narrower, so they become clogged more easily.

Fluid build-up in the middle ear can become infected, which will cause pain and other symptoms.

Causes of ear infections

Ear Infection Not Responding To Antibiotics

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What Is The Treatment For Ear Infections

Medications used to treat ear infections include:

• Pseudoephedrine to ease ear pressure
• Antibiotic ear drops for infections of the ear canal
• Neomycin
• Polymyxin B
• Steroid ear drops for infections of the ear canal
• Hydrocortisone
• Oral antibiotics for infections of the middle ear , and severe infections of the outer ear

For mild cases of ear infection, doctors often recommend watching and waiting before starting use of antibiotics, as many cases will go away on their own. Consult your childs pediatrician before giving any over-the-counter medications to your child.

Home remedies to relieve symptoms include:

• Warm compresses applied to the area to help soothe pain
• Over-the-counter pain eardrops

What You Should Not Do To Soothe A Cold Or Ear Infection:

• Do not give over-the-counter cold medicines to children under age 2. Consider avoiding them if the child is older, too.
• Do not tilt an infants crib mattress. Children under age 1 should sleep on a flat mattress with no pillows or blankets.
• Do not allow a child to drink while lying down, as it can increase the chances of getting an ear infection.
• Do not smoke. Families and caregivers who smoke increase a childs chance of getting colds and ear infections.

Because young children get more colds in the winter, they may also develop more ear infections. Five out of six children will experience at least one ear infection by the time they are 3 years old, according to the National Institutes of Health.

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