Q:I thought I would respond to the last issue of the newsletter on antibiotics. Although I agree with you wholeheartedly that these drugs are grossly overused, especially in viral disease against which they do not work, there are certain situations in which they are absolutely essential. The most important and common ones are severe acute bronchitis, pneumonia and proven bacterial middle ear infection in children.
A:When this letter came in from Kai Kermani, a GP and one of our respected panel members, we thought we would ask Alan Franklin, a pediatrician also on our panel, when antibiotics use is warranted for childhood earache. His response:"I agree that it is absolutely correct to treat a pus forming earache with antibiotics. There are several ways of determining whether or not the child is suffering from true acute otitis media, which is a bacterial infection. First, the pediatrician should have a careful look. If he sees a bright red, severely swollen eardrum, he knows that he probably has a case on his hands and ought to administer intramuscular penicillin on the spot.
"For any situation less acute than that, he should do a blood sample, and take a throat culture, which he can send to the nearest laboratory and have an answer back in several hours before administering the antibiotic.
"In my experience, it is very unusual to find true otitis media in a child. In 99 out of l00 cases, I see children with pink inflamed ears, fever and a runny nose suffering from a mild viral infection, for which antibiotics should never be given.
"For these kinds of infections, we administer a large dose of vitamin C, perhaps Calpol for the pain and fever and occasionally a decongestant like Sudofed when a great deal of catarrh is present. And then we sit back and simply watch the child get better.
"Perhaps the greatest culprit for recurrent earaches and glue ear in children between six months and six years is cow's milk. Children who are intolerant to it and suffer from increased catarrh seem to get more infections than others.
"Another culprit is maternal smoking, even before pregnancy. Children of smokers get a good deal more infections of all kinds.
"In these instances, taking children off cow's milk helps enormously."