“Ear Infections: Treat All Kids” (with antibiotics)

iStock 000013271093XSmall Ear Infections: Treat All Kids” (with antibiotics)

The title of the article above got my attention, it was a well written review, by Nancy Walsh, Staff Writer for MedPage Today(1) about a research article published on 9/2/13 (2) that recommended doctors treat all kids under 2 years of age who had acute otitis media with antibiotics. That’s a lot of kids and a lot of antibiotics for a problem that sometimes is caused by a virus. Antibiotics don’t kill viruses. We have a serious and growing problem with antibiotic resistance because of overuse of antibiotics. I had to look into it, and I’d like to share what I learned with you. The article was published in JAMA Pediatrics (2) in which researchers, based on a meta-analysis of randomized double blind placebo controlled studies among children 6 mo to 2 years old, says all kids younger than 2 years old with acute otitis media (AOM) should receive antibiotics, whether or not it is severe and whether it is in one or both ears.

I learned that in March 2012 guidelines by the American Academy of Pediatrics recommended “prompt antimicrobial treatment for children ages 6 months to 2 years with acute otitis media (AOM) with one exception: for children in whom the disease is unilateral and also unaccompanied by severe signs or symptoms, the guideline recommends, as an option, observation without initial antimicrobial therapy.” But these researchers (2) observed that was based on less strict diagnostic criteria and that it was possible some did not even have AOM. So they did this study with strict criteria and found kids treated with placebo did not do as well as those treated with antibiotics.

Otitis media is inflammation of the middle ear. Fluid builds up and can be very painful. There may be fever .A contributing factor for young children can be their short, narrow eustachian tube which can easily close off and not drain fluids when there is inflammation. An infant may have no symptoms or just be irritable. Physicians can diagnose AOM by an examination of the ear. It occurs primarily in children under 10, and is diagnosed more than 5 million times each year in the US. It is the second leading reason for children’s visits to physicians, after well-child checkups. In the United States it is the leading reason for antibiotic prescriptions for children with up to 98% treated with antibiotics.(3)

In some countries, such as the Netherlands, Denmark and Sweden, I learned most children with routine AOM are not initially treated with antibiotics, but rather with observation. If they get worse or do not improve within 1-2 days, they will get antibiotics.  Up to 80% of cases of AOM resolve in 24 hours without any treatment or regardless of treatment. In the Netherlands only 31% of cases may ultimately receive antibiotics. German physicians often use CAM, and treat only about 5-10% of cases with antibiotics. British practitioners are now encouraged to decline antibiotic treatment for routine URI’s including AOM.(4)

Usually AOM follows an upper respiratory infection (URI). It may be caused by bacteria or, virus or even fungus. Studies have shown no bacterial pathogen in up to 62% of cases. 30% of cultures of fluid in the middle ear are sterile. While antibiotics do not kill viruses, they can cause adverse effects if taken during a viral infection, Complications of AOM can include perforated eardrum, hearing loss, mastoiditis, or very rarely brain abscess or meningitis. Preventing meningitis is often cited as a reason to give antibiotics, but it would be unlikely to work for that. (3,4)

Overuse of antibiotics in otitis is a serious concern and thought to be a major cause of bacteria resistant to antibiotics. In some countries, up to 80% of streptococcus bacteria, including most strains that cause disease in children, are now resistant to penicillin. And now there are many other drug resistant strains. Overuse of antibiotics may predispose the child to increased allergies, repeated infections, weaken the immune system by killing the good bacteria in the intestine, promote yeast infections in the gut, in addition to causing diarrhea, rash, and vomiting.(4)

Because the natural course of AOM is benign 80% of the time, there is an opportunity for patients with mild, early uncomplicated cases to benefit from CAM modalities that have been used for AOM safely and with benefit. All complicated or severe cases, any child, with a high fever, listless, dehydrated or otherwise obviously ill must have urgent medical attention and be followed closely by the pediatrician and antibiotics used, as appropriate, initially, as well as any cases who are not improving.

Pure, high quality essential oils have a wide margin of safety and have been used effectively in children for AOM. They have antimicrobial activity including those effective against viruses and those effective against drug resistant bacteria. They do not wipe out the normal gut flora, do not interfere with the immune system or with healing and may first address the underlying cause such as excess mucous, which may in turn eliminate the problem and the pathogens naturally.

Chamomile and Lavender oils are examples of gentle anti-infective, anti-inflammatory, anti-allergy, calming, sedative and pain relieving oils. I agree with the excellent recommendations from Dr Mom’s Essential Oils First Aid: “dilute 50:50 lemon, Exodus II, or Raven, rub gently around the outside of the ear and over the lymph nodes on the side of the neck.” ”Lavender, Melaleuca alternifolia, chamomile, Purification, or Melrose – put a few drops of an oil onto a cotton ball, gently place in the ear and replace the cotton ball 2-3 time per day until the infection is gone”  You can also use a warm compress over the cotton plug. NEVER place oils directly in the ears. “To calm a stressed out child in pain – peace and calming, gentle baby, stress away roll-on, tranquil. For infants and small children apply to your hands and over your heart or along your neck, then hold and comfort the child while caressing. (5)  

When using oils for young children it is advised to dilute them with vegetable oil, such as warm olive oil. Dilute 50:50 or more such as1-2 drops per half tsp. Nutritional therapy is also important. Vitamin D3 can reduce repeated ear infections. Check the blood level and if low (< 30), supplement. Avoid mucous forming foods; identify food allergies and eliminate the cause. Get rid of indoor environmental pollution. Lymphatic drainage and craniosacral therapy have been of benefit. There are other CAM modalities that also can be beneficial, that I would like to cover later. I used to use many of them and now find oils work best. I have 11 years of experience using them and know what to expect. It is important to use the highest quality pure unadulterated oils or they might not work or could harm. These oils have been used safely and effectively with children and adults for many years. There has been a lot of research that confirms many ancient and modern uses and more research that is ongoing.

2.Alejandro Hoberman, MD et al, Acute otitis media in children younger than 2 years, 2013:doi:10.1001/jamapediatrics. 2013.3068
3.MKSAP 16 General Internal Medicine, 102.
4. Marcia Shapiro, MD: chapter 18, Otitis Media. In Rakel’s Integrative Medicine 2nd Edition 2007
5.Dr. Mom’s Essential Oils First Aid :coping with non-emergency mishaps in a natural way, Judy Jehn RMT, Brenda Shelton RMT, Vision publishing, 2011.


Information shared here is not intended as medical advice, and cannot substitute for professional medical advice and information. Information provided is general in nature and may be helpful to some people but not others, depending on their personal medical needs. Always consult with your personal physician before changing or undertaking a new exercise program or following advice designed for general audiences only. Never disregard professional medical advice or delay getting care because of something you have read here.

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