Recurrent ear infections and persistent effusion

Use of daily antibiotics for prevention (prophylaxis) of ear infection can reduce by 1 the number of infections that would have occurred without antibiotics. If your child has at least 3 ear infections in a 6-month period or has 4 ear infections in 1 year, your health professional may prescribe a low dose of antibiotics for your child to take daily during the season when he or she is prone to ear infections. The risks of taking daily medications include:

• Possible side effects from the medication, such as nausea or diarrhea.
• The cost of the medication.
• The risk of developing bacteria that are resistant to the prophylactic medication.

In certain circumstances, long-term use of antibiotics may be just as effective as ear tubes in preventing infection. The value of long-term antibiotic use should be weighed against the risk that your child may develop bacteria that are resistant to the medication.

If your child has persistent infection in spite of multiple antibiotics, your doctor may wish to remove fluid from the middle ear space (myringotomy). This fluid will be sent to a lab for culture to identify which bacteria are causing the infection and help identify the best antibiotic to use to fight the infection. Ear tubes may be placed at this time to help drain the fluid.

In some children, fluid behind the eardrum (effusion) lasts for longer than 3 months after an ear infection. If hearing loss is present, antibiotics or ear tubes may be appropriate treatment choices. If your child still has fluid and hearing loss after 4 to 6 months, your doctor may recommend ear tubes. Ask your doctor about the long-term risks and benefits of continued observation, antibiotic use, and ear tubes.

Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated February 23, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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