Prevention

Although the causes of otitis media aren't fully known, several factors increase a child's risk for developing ear infections:

Bottle-feeding. Bottle-fed babies are two to three times more likely to develop otitis media in the first year of life than are breast-fed babies. Breast milk may have antibodies that ward off the infections. Also, when a child sucks a bottle while going to sleep, the milk can be forced into the middle ear, perhaps leading to infection.

Second-hand smoke. Studies have shown that children whose parents smoke are nearly three times more likely to develop middle ear fluid than children whose parents don't smoke. They also take longer to recover.

Group childcare. Because they're exposed to a wide variety of cold viruses, children in group child-care facilities have a greater chance of developing ear infections than children cared for at home.

Allergies. Allergies can increase a child's likelihood of ear infections because watery mucus from the nose can clog the eustachian tube and prevent it from draining properly. That's why doctors sometimes prescribe antihistamines to help clear up middle ear fluid. The AHCPR panel did not find enough scientific evidence to support that treatment, however, and did not recommend it.

Birth defects. Certain conditions such as cleft palate, Down syndrome, and nervous system abnormalities can increase a child's chances of developing ear infections. The panel's recommendations don't apply to these children, who should be evaluated individually by their doctors.

Panel Recommendations

The AHCPR panel recommendations are summarized in a consumer booklet called "Middle Ear Fluid in Young Children." Free copies are available through the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; telephone (1-800) 358-9295. Free fax copies are available by faxing to (301) 594-2800; after dialing, push "1."

Common Antibiotics for Ear Infections

Many antibiotics are approved by FDA to fight otitis media, although most doctors rely on a few favorites. Drug manufacturers have made a number of the drugs in liquid fruity flavors palatable to kids. Most antibiotics fall under four families: penicillins, cephalosporins, sulfonamides, and erythromycins. Here are some common brand names.

Amoxicillin: A generic name for the most common antibiotic used to treat ear infections. This is a synthetic penicillin. Physicians like it because it causes less diarrhea than some other antibiotics, it's absorbed well, and it's only given three times a day. It's also inexpensive. Side effects may include mild diarrhea and rashes. If the rash itches, the child might be allergic to the drug.

Pediazole: A brand-name combination of erythromycin and sulfisoxazole. Can be used if a child is allergic to penicillin. Side effects may include some abdominal cramping and discomfort and, infrequently, nausea, vomiting and diarrhea. If any rash develops, the drug should be discontinued.

Bactrim and Septra: Two brand names of a sulfonamide drug combined with trimethoprim. They can be used in children who are allergic to penicillin. Side effects may include mild nausea, vomiting, diarrhea, rashes, an increased sensitivity to sunlight, and a reduction in white blood cells.

Ceclor: A brand name of a cephalosporin antibiotic that is effective, but expensive. Side effects may include diarrhea and a rash. Children may be allergic to cephalosporins if they're allergic to penicillin. Some newer cephalosporins include Ceftin, Cefzil, Vantin, Suprax, and Lorabid.

Gantrisin: In its liquid forms, Gantrisin is a brand name for acetyl sulfisoxazole and is often used as a preventative drug for children with recurrent infections, because it's given only once a day. It's approved for acute otitis media when used in combination with penicillin or erythromycin.

Augmentin: An amoxicillin drug with extra ingredients to inhibit bacterial resistance. May clear up infections when other drugs have failed.

Despite the number of antibiotics available to treat ear infections, FDA is concerned about the growth of increasing numbers of bacteria resistant to antibiotics.

"The agency is actively pursuing the establishment of a surveillance program for all antimicrobial products," says Albert Sheldon, Ph.D., a microbiologist in FDA's division of anti- infective drug products.

Last year, FDA asked manufacturers of new drugs seeking FDA approval to track their effect on certain strains of bacteria. FDA officials also participate in professional organizations that track bacterial resistance both in this country and around the world.

One way for parents to combat bacterial resistance is to be vigilant in giving each dose on schedule. Skipping or delaying doses can encourage resistant bacteria to develop.

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About the Author

FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.