The Rise of Drug-Resistant Superbugs

Just past midnight on a warm spring evening, eight-month-old Susan, who's had a stuffy nose and cough for the past two days, wakes up screaming. Seeing the baby tugging at her ear and looking utterly miserable, Mom takes her temperature and discovers she has a fever. The next morning, instead of dropping her daughter off at the daycare center, Mom calls her boss and tells her she won't be in that day. Then, she and Susan head off to the pediatrician's office, where a middle ear infection, also known as acute otitis media (AOM) is diagnosed.

Otitis media is one of the most common childhood infections, causing more visits to the doctor (more than 30 million each year!) than any other medical condition. Middle ear infections are often associated with upper respiratory illnesses (URI's) such as colds. According to Michael Rothschild, MD, F.A.C.S., F.A.A.P., an Associate Professor, Departments of Otolaryngology and Pediatrics at the Mt. Sinai School of Medicine, New York, "URI's cause swelling in the nasal passages and in the walls of the Eustachian tube, which is the ear's natural drainage pathway. This swelling prevents the tube from effectively carrying out its drainage functions, allowing viruses and bacteria to move from the nose to the middle ear and increasing the likelihood of an ear infection."

A December 2001 survey done by the National Association of Child Care Professionals found that the vast majority of pediatricians said that their youngest patients—those age two and under—who attend group daycare have a higher rate of repeated middle ear infections than those who do not. The study revealed that 50 percent of infants and toddlers in group childcare experience an average of four bouts of otitis media per year, in contrast to only 26 percent of youngsters not in group care who suffer from repeated infections. Most alarmingly, 91 percent of pediatricians surveyed reported increased antibiotic resistance in those youngsters, finding that fully one third of children in group daycare do not respond to the first antibiotic selected for treatment. The overuse of antibiotics for illnesses like colds and the flu, which are viral and not responsive to antibiotic treatment, has caused infection-causing bacteria to grow stronger, and drug-resistant strains of bacteria to become more common.

”One of the most important ways to stem antibiotic resistance is to make sure these powerful drugs are prescribed only when necessary,” says Dr. Rothschild.

Until recently, all children with ear infections were given antibiotics. New research from the Agency for Healthcare Research and Quality has shown that 80 percent of middle ear infections will get better within one week without treatment, and with no ill effects. If a child with otitis media has pus behind the eardrum or displays other clear signs of a bacterial infection, medication is usually warranted, with amoxicillin generally being the initial drug of choice. For difficult-to-treat middle ear infections, for children who have received an antibiotic within the last three months for their current infection, or for youngsters under two years or those in group child care, the Centers for Disease Control (CDC) recommends Augmentin (a combination of amoxicillin and clavulanate) as the first-line treatment. Youngsters who suffer recurrent middle ear infections may have tiny tubes surgically placed in the ear that prevent fluid buildup and reduce the risk of bacteria getting trapped. Prevnar, a vaccine effective in preventing invasive disease caused by streptococcus pneumoniae, one of the main bacteria which causes otitis media and other infectious diseases, is now included in the recommended list of childhood immunizations and may decrease the risk of recurrent middle ear infections.

The National Association of Child Care Professionals says that parents can reduce these tough-to-treat infections by ensuring that antibiotics are taken correctly, with the entire course of medication being given even if the child seems fine within a day or two. Antibiotics should not be "saved" for future use, nor should a medicine prescribed for one child be given to another with similar symptoms. Parents should understand that viral infections do not respond to antibiotics, and should not urge their healthcare provider to prescribe them if they are not needed.

Understanding your child's diagnosis is important, says Dr. Rothschild, because fluid in the ear ("sterile" effusion without infection) may not need to be treated with antibiotics even if the ear appears red.

The National Association for Child Care Professionals is involved in an ongoing educational campaign to increase awareness among child care professionals and parents about antibiotic resistance, otitis media, and the impact of antibiotics on children's health. Another goal is to provide information about the measures that can be taken to reduce the incidence of tough-to-treat ear infections in children attending daycare. In most states, licensed child care facilities are mandated to isolate all children with fevers and send them home, not allowing them to return until the fever has been down for twenty-four hours. Dr. Rothschild points out, "Some daycare centers permit the children to return more quickly if they are receiving antibiotics. This puts pressure on working parents to request antibiotic treatment even if it is not appropriate for their child's condition."

Preventing the continued proliferation of drug-resistant "superbugs" is an important public health priority for this century. Parents and child care professionals can do their part by learning more about ear infections, becoming knowledgeable about the use and misuse of antibiotics, and carefully following the advice of their healthcare providers.