Sep. 15, 1998 By Corey Stevens
GAINESVILLE, Fla.---Serious complications from childhood ear infections are on the rise, primarily because the bacterium most often responsible for the infection is growing increasingly resistant to antibiotics, University of Florida researchers report.
While physicians nationwide have recognized ear infections are becoming more difficult to treat, a UF study is among the first to provide concrete evidence that complications from ear infections are becoming more common, said UF otolaryngologist Dr. Patrick J. Antonelli, who is scheduled to present his findings Tuesday (9/15) at the American Academy of Otolaryngology-Head and Neck Surgery meeting in San Antonio.
Researchers reviewed the hospital records of all patients admitted to Shands hospital at UF during the past 10 years with complications of ear infections. In that time, 34 patients were admitted for mastoiditis, a serious ear complication of middle ear infections that involves the spread of the infections into the middle ear bone. Although the number is not large in itself, Antonelli says it is significant because this type of ailment has been almost nonexistent since the widespread introduction of antibiotics in the 1940s.
"It has been extremely rare in the last 20 to 30 years to have mastoiditis develop from acute ear infections. With the rising incidence of certain penicillin-resistant bacteria, this has the potential of growing into a serious problem. This has only recently become widespread with the most important type of bacteria that causes acute ear infections, so we are only seeing the tip of the iceberg," said Antonelli, an associate professor of otolaryngology at UF's College of Medicine.
Researchers tested the bacterium responsible for a majority of childhood ear infections and the rising rate of mastoiditis, streptococcus pneumoniae, for its susceptibility to antibiotics and found it was penicillin-resistant in all but one of eight tested samples.
"As bacteria become resistant to antibiotics because of overuse and preventative use, more serious infections are likely to develop," Antonelli said.
As antibiotics lose their effectiveness for treating infections, he warned, more and more children will be hospitalized to receive antibiotics intravenously and surgery may be needed. Thirty-four percent of patients in the study needed surgery.
"The possibility for life-threatening complications increases because younger children, with less-developed immune systems, are at a higher risk for developing these infections. Deaths due to ear infection complications were not uncommon before the introduction of antibiotics," Antonelli said.
During the course of the study, the number of complications from ear infections increased and the age of patients decreased. Patients' ages ranged from 61 days to 52 years, but the average was 10 years. Thirty-seven percent of patients in the study were younger than 2 years old.
Each year, about 13 million children under age 5 suffer an acute ear infection. Although most of those infections are bacterial, they usually do not require the use of an antibiotic, but do take about a day longer to clear up without a prescription, Antonelli said.
"Physicians have to be more selective about offering antibiotics to children. It shouldn't be for a runny nose or a low-grade fever. Giving antibiotics for recurring ear infections as a prophylactic works for a while, but then bacteria can become more resistant and harder to treat," Antonelli said.
To decrease the chances of a child getting complicated ear infections, Antonelli recommends breastfeeding, avoiding exposure to tobacco smoke and using daycare with groups of less than six children. If an antibiotic is prescribed, the whole course should be completed to ensure the bacteria is killed.
Hospitals do have certain antibiotics they hold in reserve to treat resistant bacteria. Antonelli says he believes health-care professionals have done a good job using them sparingly, but he cautions that relying on antibiotic variation alone won't solve the problem of resistance.
"Once those antibiotics stop working, we may be in trouble," he said.
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