Antibiotics are pharmacological agents meant to treat infections by targeting the responsible bacteria. The correct use of antibiotics treats many life-threatening bacterial infections thus saving lives. Conversely, wrong antibiotic application leads to antimicrobial resistance, which the European Union estimates to cause at least 25,000 mortalities and economic losses of 1.5 billion euros yearly (Hamre et al., 2014).
Community resistance to antibiotics complicates the treatment of common bacterial infections. Other side effects of antibiotic use include diarrhea, itchiness, queasiness, indigestion, and coughing. Children with acute respiratory tract infections such as sore throat (pharyngitis) and ear infections such as otitis media often receive unnecessary antibiotic prescriptions. The purpose of this paper is to discuss antibiotic therapy when treating ear and throat pain in children and adults. Professional guidelines and recommendations regarding antibiotic use in these two situations are also provided.
Antibiotic Therapy When Treating Ear and Throat Pain in Children and Adults
The scientific name for infections of the ear canal is acute otitis externa (AOE). In contrast, illnesses that affect the middle ear are called otitis media. Otitis media with effusion (OME) happens when fluid accumulates in the ear and does not cause signs of infection such as discomfort, fever or pus. Acute otitis media (AOM) is characterized by the accumulation of fluid due to bacteria or viral infections. Most antibiotic prescriptions in childhood are meant to treat AOM and often result in adverse effects in 4 to 10% of children (CDC, 2019).
This disorder may not benefit from antibiotic therapy in some cases because the immune system can ward off the infection. Similarly, OME does not require antibiotics and often resolves with watchful waiting, which can be described as the process of allowing the body to fight off infections naturally while managing other associated symptoms. Analgesics such as ibuprofen or acetaminophen can be used to relieve ear pain in these infections.
Streptococcal pharyngitis is common in children between 5 and 15 years even though it can affect adults. However, throat pain may also be caused by viral infections. Therefore, it is necessary to ascertain the etiology of throat pain before initiating antibiotic treatment. Recovery in uncomplicated cases takes between 3 and 4 days.
Professional Guidelines and Recommendations Regarding Antibiotic Use in Ear and Throat pain
Antibiotic prescribing guidelines bring about benchmarks of care, direct quality enhancement endeavors, and boost patient outcomes. The Centers for Disease Control and Prevention [CDC] has established a set of guidelines that govern the use of antibiotics for the treatment of ear pain in children (2019). These guidelines also apply to the management of the same disorders in adults. Mild cases of ear pain in AOM in children below the age of 2 years are appropriate for watchful waiting.
Amoxicillin is the first line treatment for children who have not used it in the last one month. If the drug has been taken within that time, amoxicillin/clavulanate should be given (CDC, 2019). This combination is also indicated in cases of resistance to amoxicillin alone or if the patient also presents with purulent conjunctivitis. Patients who have known allergies to penicillin can receive ceftriaxone, cefuroxime, cefdinir or cefpodoxime (CDC, 2019). Prophylactic antibiotics are contraindicated in the prevention of ear infections.
Unnecessary antibiotic use in throat pain can be avoided by using rapid antigen detection tests (RADTs) to confirm bacterial etiology. However, many false positives can occur in winter following colonization of asymptomatic individuals by group A beta-hemolytic streptococci (Dut & Kocagöz, 2016). The first line treatment for these infections is amoxicillin and penicillin V. Nonetheless, clindamycin, cephalexin, clarithromycin, azithromycin, or cefadroxil can be used in patients with non-type I hypersensitivity to penicillin. For type I hypersensitivity, clarithromycin, clindamycin, or azithromycin are endorsed. The suggested therapeutic course is 10 days.
Antibiotics are beneficial in bacterial infections. However, incorrect usage leads to adverse reactions and builds antibiotic resistance. Inappropriate use of antibiotics can be reduced through proper educational interventions, RADTs to diagnose viral infections, and watchful waiting. Patients can receive analgesics instead of antibiotics to manage the pain associated with ear and throat infections.
Centers for Disease Control and Prevention. (2019). Pediatric treatment recommendation. Web.
Dut, R., & Kocagöz, S. (2016). Use of Streptococcal tonsillopharyngitis diagnostic tests in children. Journal of Pediatric Infectious Diseases, 11(04), 126-130.
Hamre, H. J., Glockmann, A., Schwarz, R., Riley, D. S., Baars, E. W., Kiene, H., & Kienle, G. S. (2014). Antibiotic use in children with acute respiratory or ear infections: Prospective observational comparison of anthroposophic and conventional treatment under routine primary care conditions. Evidence-Based Complementary and Alternative Medicine, 2014, 1-17.