Antibiotics Aside

Even so, some skeptics are beginning to question antibiotics’ near-universal use for AOM — including parents like Rebecca Keith, a Seattle mother of two, who has experienced firsthand antibiotics’ law of diminishing returns. Her son Alec, now five, began suffering frequent, painful episodes of acute otitis media when he was one. “For the first year, he was on amoxicillin a lot,” Keith recalls. “But after a while it stopped working. So we went through a string of others: Septra, Augmentin, Vantin, you name it. Sometimes he’d have to take three different drugs in a row before the infection would finally clear up.”

Doctors confirm that antibiotic use can create a climate in which antibiotic-resistant bacteria can thrive — not only in the general population but also inside the user’s body, as may have happened in Katie Michaelson’s case. “Unnecessary antibiotic use may increase your child’s risk of contracting a resistant infection and lead to prolonged or recurrent illnesses,” says the CDC’s Benjamin Schwartz. But there may be alternatives. Dr. Jennifer Jacobs, a Seattle-area family practitioner, says she has been successfully treating children’s ear infections with homeopathic remedies for 15 years, although she does prescribe antibiotics when there’s no improvement after a few days. She’s now conducting a clinical trial to test her homeopathic treatment. One child who participated in the study is Alec Keith. “Alec’s ear infection improved dramatically over the period he was involved in the study,” his mother reports. “But since it’s a double-blind trial, we don’t know whether he got the homeopathic remedy or a placebo.”

If Alec did get a placebo, he may have received the most cutting-edge AOM treatment of all: nothing. Dr. Larry Culpepper, a physician and professor of family medicine at Brown University, speculates that letting nature take its course may prove to be the wisest initial approach to ear infections — assuming a child’s fever or symptoms don’t persist. Culpepper has studied this watch-and-wait approach in the Netherlands, where it was adopted as a nationwide guideline after a series of studies showed little benefit from initial treatment with antibiotics and no risk from withholding them. (In a study of 6,900 cases, Culpepper says, one child developed a complication — mastoiditis — which was quickly cured with antibiotics.)

Still, Culpepper worries that the American healthcare safety net is too fragile for the Dutch method to work. “In the Netherlands, everyone has health care coverage, and many people live within walking distance of their physician; if your kid isn’t improving, it’s easy to get her to the doctor,” he says. “Our primary-care system is in a shambles; follow-up for many kids is spotty at best. For now, we need more evidence. I think we should err on the side of caution and stick with antibiotics.” Even without a wholesale revision of standard pediatric practice, experts say the fight against antibiotic-resistant infections is far from hopeless. In Iceland, for instance, cases of penicillin-resistant pneumococcal infections dropped 15 percent in a single year after health experts waged a campaign against antibiotic overuse.

“Nature has adapted,” David Smith concludes. “Now we just have to be smart enough to deal with it.”