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For the first nine months of her life, Olivia Booth was constantly plagued by painful ear infections. Doctors tried eight or nine different types of antibiotics. Some of the drugs made the Grapevine, Texas, infant break out in hives, prompting physicians to halt treatment for a week, then turn to another antibiotic. But the ever-changing batteries of therapy yielded nothing.
“We did Ceclor, Biaxin, Augmentin, Zithromax, you name it,” recalled her mother, Linnea. “One infection lasted six or seven weeks because we had to keep taking her off the different antibiotics.”
Health experts say the majority of the 24 million American children who contract ear infections each year probably do not need antibiotics. Public-health officials say that the condition, technically known as otitis media, is the biggest single factor contributing to overuse of the drugs and speeds up acquisition of drug resistance in bacteria. About half of the bacteria that most commonly cause ear infections now are believed to be resistant to antibiotics.
The U.S. Centers for Disease Control and Prevention says otitis media accounts for more than 30 million physician office visits a year, compared with 9.9 million in 1975. Reasons include the increased use of day care, misdiagnoses and the rise of managed care, which encourages parents to arrange regular doctors' office visits for their children.
“Americans like quick fixes, and patient satisfaction has become a very important financial consideration for doctors,” says Gail Cassell, vice president of infectious diseases research at drugmaker Eli Lilly & Co. and a past president of the American Society of Microbiology. “An urgent need exists to improve selection of antimicrobial drugs in clinical practice.”
In fact, there are two types of otitis media, and only one requires antibiotics. Acute otitis media is characterized by pain, fever, inflammation and pus behind the eardrum and can be treated with the drugs. Otitis media with affusion often follows the acute form and features clear fluid behind the eardrum. Public-health officials estimate if doctors held back and didn't prescribe any drugs for the second variety, 8 million unnecessary courses of antibiotics could be avoided each year.
However, societal pressures often discourage such restraint. Day-care centers often refuse to readmit sick children unless parents can show they are taking medication. Sometimes there are valid fears: The CDC found a multidrug-resistant strain of pneumococcal bacteria originating from one child at an Ohio day-care center had spread to other children, staff and family members. It caused recurring ear infections in 20 percent of the children at the center and later moved into the community. The CDC recommends that when doctors feel they do not need to prescribe antibiotics for a sick child, they should write a note to day-care administrators explaining why the child doesn't require the drugs.
In the long run, experts say the public needs to acknowledge that antibiotics have their limits and don't cure every malady. Jay Portnoy, chief of allergy and immunology at Children's Mercy Hospital in Kansas City, Mo., says antibiotics should only be administered in limited cases of upper-respiratory infections.
“We often give antibiotics because we want to do something to placate anxious patients,” Portnoy wrote last year in Pediatric News. “We find that the agents work anecdotally, and everyone else gives them. [But] routinely giving antibiotics reinforces parental expectations that children will get [antibiotics] in the future. It also fosters a feeling among parents that physicians who don't give antibiotics aren't good doctors. A prescription for an antibiotic . . . sends parents the message that their child is really sick.”
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