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Q.
My toddler has repeated ear infections, so she's constantly on antibiotics. Should I be worried about the long-term effects of these drugs?
A. The first question to ask is whether the use of antibiotics is indicated each and every time your toddler has an ear infection. Recent studies have shown that for many, the WASP approach (which stands for wait and see prescription), might be the approach many of us can adopt for ear infections. Ear infections are among the most common infections in children that are treated with antibiotics. For many, the infections are caused by viruses and not bacteria. In many cases, the toddlers will settle down with pain management and time. While it is critical to treat those children at risk for worsening outcomes — infants under six months and those who are very sick — it might be appropriate to adopt a wait-and-see approach for less severe cases. One of the major concerns we have is that the widespread use of antibiotics has led to antibiotic resistance as our bugs get smarter. This in turn, on a community level, has been described as one of the world's most pressing public health problems. Kids have the highest rate of illness that are treated with antibiotics, so it makes sense that they also have the highest rate of illnesses caused by these resistant bugs.
On an individual basis, as one of my immunologist colleagues points out, as long as there are no rashes or diarrhea, then there is probably no problem (even though rare side effects can always happen). It is important to exclude other possible underlying reasons for the infection. Although many kids will outgrow these problems after a few years, some repeated ear infections can be due to allergy, antibody or immune deficiency, unsuspected sinusitis, or cystic fibrosis.
It is important to recognize that antibiotics are not useful to treat viruses. As well, for many children with repeated ear infections, an ear, nose and throat consult might be merited to explore other options of treatment. As always, your physician is best to discuss with you, the treatment strategy for your child.
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