Antibiotics for Ear/Sinus Infections in Pediatrics Simplified: High Dose Amoxicillin
During the 1980’s and 1990’s, there were many new oral antibiotics that hit the market. They were largely aimed at pediatricians for use against the few different types of bacteria that were causing the majority of ear and sinus infections and pneumonia. Unfortunately, they caused a large increase in resistant bacteria and were overused by some pediatricians and adult primary care doctors. Frankly, it was a sort of “heyday” for drug reps, visiting pediatricians and family practice doctors in their offices and marketing these drugs. The office cabinets were kept full of “free samples” of these brand-named new antibiotics.
The overuse of antibiotics is still going on….pediatricians need to be careful not to prescribe antibiotics for viral infections that do not appear to involve bacterial complication. There has been a lot of guidelines developed on how to differentiate “simple” viral infections from bacterial ones.
Back in 1999, the CDC ran some great studies that found that good ‘ole generic Amoxicillin in roughly twice the normal daily dose, given only twice/day, works much better against common bacterial ear/sinus infections than the other more expensive drugs. So that has been the standard and it works extremely well…..still, 14 years later! However, there is still some “under dosing” of amoxicillin by some ER’s and Urgent Care Centers staffed by non-pediatric providers.
Generally, in our practice, it is no longer an issue convincing patients to use this simpler treatment. In fact, we now no longer treat some ear infections and wait several days to see if resolution occurs by itself. Viral infections do account for at least half of all typical ear infections. Depending on the age of the child, some of these may convert to bacterial and guidelines for antibiotic treatment are clearly based on age and severity of symptoms. It needs to be said that some children in day-care centers do have highly resistant bacterial infections requiring a stronger antibiotic (broad-spectrum) to clear the bacterial infection.