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The Informed Parent

The Ear Infection That Won’t Go Away

by Shanna R. Cox, M.D., F.A.A.P.
Published on Sep. 16, 2013

Most children will have at least a few ear infections throughout their childhood. These tend to occur most commonly before kindergarten age. The infant and toddler anatomy often plays a large role in the development of ear infections. Secretions aren’t able to drain quite as effectively with the horizontal position of their Eustachian tubes. Once the ear has been examined, and if it appears distorted, with purulence, or is judged by tympanogram to be flat, or dysfunctional, antibiotics are initiated to clear the infection. If these criteria are not met, the child may be observed and rechecked with the development of new symptoms.

However, there are times even after appropriate treatment is initiated that an ear infection may persist or recur. There are several factors that may contribute to this situation, and new research published in The Pediatric Infectious Disease Journal gives important insight into these cases.

In working with more than fifty children who experienced recurrent ear infection, the researchers used tympanocentesis to obtain the fluid that was behind the eardrum. This fluid was then able to be cultured in a laboratory to examine which type of bacteria was present. The results revealed that nontypeable Haemophilus influenza was the bacteria most often present in these cases. This is a significant finding for clinicians, as this type of bacteria is known to have penicillin resistance. Many practitioners have used amoxicillin as a first line treatment for ear infections in efforts to minimize the development of resistance. As pathogens have changed, there is less and less of a role for simple amoxicillin.

The recommended treatment for nontypeable H.influenza includes combining amoxicillin with a beta lactamase inhibitor like sulbactam, or changing to a different class of antibiotics such as the second or third generation cephalosporins, fluoroquinolones, or macrolides. This hard data is an important tool for discussion with families and for clinicians to make the most effective antibiotic choice for these common infections.

As always, a recheck in the office is recommended to assure clearance of the infection is achieved.

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