Just Say No

Each year, more than 100 million antibiotic prescriptions are issued in the United States, and many of those are written for children. Last fall, a coalition that included the CDC and the American Medical Association launched a nationwide publicity campaign to promote the more judicious use of antibiotics. Among the key targets for their message: parents, pediatricians’ offices, and childcare centers.


The most obvious problem, say Smith and other experts, is that millions of prescriptions are issued yearly to treat colds, coughs, ear infections, and upper respiratory infections. But many of those maladies are caused by viruses, not bacteria, and antibiotics have no effect on viruses. “We could reduce antibiotic use significantly if we stopped prescribing them for colds,” says Dr. Benjamin Schwartz, a childhood disease expert at the CDC.

Why would a physician dispense a virtually useless drug for a condition likely to clear up on its own? Smith says it’s a combination of pressure from parents who believe there must be a pill for everything and the tendency of many doctors to go for a quick fix rather than letting nature take its course. The assembly-line nature of modern health care and doctors’ fear of malpractice suits may also come into play. Middle Ear Muddle The single biggest reason for giving antibiotics to kids is ear infections. About one out of every three meetings between child and physician concerns an ear infection, or what doctors call otitis media. And in the United States, treatment almost always consists of a ten-day course of antibiotics. The drug most often prescribed for otitis media — the pink bubble-gummy liquid called amoxicillin — ranks right up there with sippy cups, Big Wheels, and Barney as an icon of modern child-rearing.

Are antibiotics overprescribed for ear infections? The answer is yes — and no. Part of the uncertainty stems from the fact that more than one type of otitis media exists: acute otitis media (AOM), an infection that causes the middle ear to redden and fill with fluid; and otitis media with effusion (OME), a condition in which there is fluid but no swelling or redness. OME rarely produces pain and fever and often goes unnoticed by parent and child. Yet it is often treated with antibiotics and sometimes the insertion of fluid-draining tubes into the eardrum, because of the fear that OME lasting more than three months could impair a child’s hearing.

However, a panel convened to study treatment of OME found that a wait-and-see approach may be the best medicine: In about 85 percent of cases, the panel found, the ear fluid goes away on its own. And there’s virtually no evidence that children suffer long-term hearing loss as a result of OME. “I don’t recommend antibiotics for a child who just has fluid in the ear,” says Dr. Alfred Berg, a professor of family medicine at the University of Washington and co-chair of the federal panel. “But for AOM, most doctors believe the benefits of initial treatment with antibiotics far outweigh the risks. That’s because, though rare, serious complications can ensue from untreated AOM.”

According to Dr. Marc Weissbluth, a Chicago pediatrician, “In a small number of cases, bacterial infections can lead to deafness, meningitis, and mastoiditis. Antibiotics are a safeguard against that.”