THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Tuesday, January 14, 1997 TAG: 9701140209
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 115 lines
Cherlanda Munford of Norfolk knows the symptoms well. First, her 4-year-old son, Breon, starts pulling at his ear. Then he complains about a headache. Then he spikes a fever.
Then she knows he's got an ear infection.
She also knows the treatment. A thick, pink liquid that smells like bubble gum spooned into his mouth three times a day for 10 days.
Goodbye, infection.
But a study in the January edition of the journal Pediatrics offers Munford and other parents another option.
The study, conducted by a group of infectious-disease specialists in Boston, concluded that one shot of a broad-spectrum antibiotic called Ceftriaxone is just as effective at treating ear infections as a 10-day dose of antibiotics.
``We found the parents loved it,'' said Dr. Jerome O. Klein, professor of pediatrics at Boston University's School of Medicine and one of the study's authors. The one-time shot also eliminates compliance problems, he said, because physicians don't have to worry whether their patients will take the medicine properly.
The study was funded in part by a grant from Roche Laboratories, which manufactures Ceftriaxone.
But several local pediatricians said Monday that treating an ear infection with a high-voltage antibiotic like Ceftriaxone, typically used to treat more serious bacterial illnesses, such as pneumonia and meningitis, is overkill.
``You may be killing a fly with a shotgun,'' said Norfolk pediatrician Bobby J. Garrison. ``This is really a big-gun antibiotic, one of the things we hold in reserve for the worst-case infections.''
Using it to treat ordinary ear infections, he said, could cause the bacteria to become resistant to the drug. Then, if the child gets a more serious illness, the antibiotic might be worthless.
``All of us are concerned about the potential overuse of broad-spectrum antibiotics and the development of resistance where we're left with nothing,'' said Douglas K. Mitchell, infectious-disease specialist at Children's Hospital of The King's Daughters, Norfolk.
Ear infections, or otitis media, are some of the most common ailments in children, accounting for one-third of all pediatric visits. Two out of three children will have an ear infection by the time they are 2 years old, according to the American Academy of Pediatrics.
Ear infections occur when the eustachian tubes swell and block drainage of fluid from the ear to the throat. Kids tend to get a lot of infections because their eustachian tubes are so small and narrow.
Klein, one of the study authors, said he doesn't think the shot is overkill.
While more research is needed on the resistance issue, he said, a single dose of Ceftriaxone that stays in the bloodstream for three to five days may put less of the drug into the child than the 10-day course of oral antibiotics.
Cost is another issue, local doctors said. Ceftriaxone, which runs about $60 a dose, costs nearly twice as much as oral antibiotics like amoxicillin.
Chesapeake pediatrician Dr. Sue Lee already uses Ceftriaxone to treat resistant ear infections, those that don't go away with the initial course of antibiotics. But she usually follows the shot with more oral antibiotics.
The report in Pediatrics convinced her the shot is probably enough, she said.
But she still won't give the shot to every kid with an ear infection.
One reason is that if the child has an allergic reaction, there's no way to ``suck that stuff back out,'' she said, and the reaction will continue for the next three to five days. Oral antibiotics like amoxicillin remain in the bloodstream for only about 12 hours, she said.
There's also a danger in giving children too many shots, noted Dr. Robert Fink, a pediatrician with offices in Norfolk and Chesapeake.
For instance, a penicillin shot can be used to treat strep throat, but he rarely recommends it.
``I hate to subject a child to the shot unless they can't take oral medications,'' he said. ``They develop a fear of coming to the doctor every time they're sick - and when you're trying to examine a screaming child's ears, it makes it very difficult to get a clear diagnosis.''
Still, he said, he would use Ceftriaxone for children who are vomiting or who refuse to take oral antibiotics.
That won't be Munford's kids.
``I'll stick with the medicine,'' she said Monday from the ambulatory-care clinic at King's Daughters, where her younger son Rodney was being treated for his first ear infection.
``They may say the shot works, but I know the medicine works.'' ILLUSTRATION: Color photo by BILL TIERNAN/The Virginian-Pilot
Dr. Carolyn Moneymaker examines Rodney Munford Jr., 1, who came to
Children's Hospital with both ears infected.
Graphic
[Box]
EAR INFECTIONS
Ear infections are getting more prevalent, says Norfolk
pediatrician Bobby Garrison. Reasons include increased indoor and
outdoor pollution, but the biggest reason, he says, is the
increasing numbers of children in large day-care centers, where
disease-bearing organisms flourish and spread.
Garrison recommends that parents whose children have recurring
ear infections:
Don't give bottles or pacifiers while the child is lying down.
Control allergens, such as cigarette smoke, in the home.
Move the child out of large-group day care.
Researchers are testing a vaccine for pneumoccocal bacteria, one
of the causes of ear infections, on children under age 2. The
vaccine won't prevent all ear infections, but might reduce the
incidence, said Dr. Douglas K. Mitchell, an infectious-disease
specialist at Children's Hospital of The King's Daughters, Norfolk.
Graphic
Illustration by KRT
An infected middle ear
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KEYWORDS: EARACHES EAR INFECTIONS ANTIBIOTIC CEFTRIAXONE