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Comment by ashark | Hacker News Reader

I wish it were easier to avoid their use, but without antibiotics my kids would spend like half the year with ear infections, miserable (and making everyone else miserable) and lethargic at best. Then there's strep—last year I discovered the hard way how dangerous that can be if you don't treat that very soon after symptoms start (I'd never had it, didn't realize what was happening/how serious it was at first)

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I think that the challenge we have is that today's antibiotics are really like the proverbial "sledgehammer to crack a nut".

There hasn't been a great deal of interest in discovering new antibiotics, as this extract from Wikipedia describes:

  Following a 40-year hiatus in discovering new 
  classes of antibacterial compounds, four new 
  classes of antibacterial antibiotics have been 
  brought into clinical use in the late 2000s and early
  2010s

I assume that there isn't much interest due to the limited financial rewards to the pharmaceutical industry.

What is really needed is a new way to target the truly " foreign " and trouble making bacteria in the body, and eradicate it. Hopefully in the next 40 years we can make such a breakthrough and stop the "carpet bombing" methods we have today.

Most of the antibiotics you're going to get from your PCP are old chestnuts like amoxicillin (1972) and doxycycline (1967).

Having lived in the US and moved to Austria, I can say it's quite comical how few times doctors prescribe antibiotics here. It's something like 10:1.

At times this is frustrating because you want the easy fix and when antibiotics work they work really well.

It's also quite illuminating how many symptoms do not seem to benefit from taking antibiotics even when they are the knee-jerk treatment.

I sometimes joke that modern medicine is 50% prescribing cortisone and antibiotics.

The following anecdote may not really be applicable to children, but you might find it interesting anyway. I went through a period of getting an ear infection, being prescribed antibiotics, having it clear up, but then having it recur sometime later. After quite a few goes round this loop I decided to just take painkillers (ibuprofen was very effective for me) and wait it out, and the infections stopped coming back.

Ear infections aren't always bacterial. They can be fungal. Antibiotics will do zero if it's fungal. Do NOT go to a general practitioner with an ear infection. They will prescribe antibiotics and tell you to get lost. Bad idea. Go to an ENT (ear-nose-throat doctor) instead. They have the right equipment on hand and the experience necessary to properly identify what you have and how to treat it. They will take away the pain in minutes by relieving pressure using specialized equipment. Huge mistake to go to a regular doctor.

Pediatric doc here. True, many are not bacterial but fungal ear infections are quite rare. The majority of otitis media is viral, which is not surprising given the concurrent URI that most kids (and adults) have when they get a painful ear. This is also the reason I try to have parents wait out ear infections in their kids ... I'd rather not use antibiotics, especially when they have a viral infection that wouldn't respond anyway. I'm not sure what tools you're referring to in the ENT office. If the ear infection is external (i.e. Swimmer's Ear) any GP office should be able to culture and treat it. If it's a middle ear infection (and that's usually what we're talking about), an ENT still has to deal with the fact that the tympanic membrane blocks access to the middle ear. Only in very extreme cases would an ENT consider violating the TM to sample the middle ear.

> I'm not sure what tools you're referring to in the ENT office.

I don't know the exact terminology, but it's essentially a vacuum with a thick needle point. They use it to suck out and clean the debris from inside the ear. All the pus and other liquid in there. You regain your hearing and the pain subsides. They can then put the medicine in after.

I've only had fungal infections, so I can't speak to viral or bacterial. For fungal, they essentially treat it with vinegar and steroids. The vinegar kills the fungus and the steroid is for inflammation. I had to pay $100 bucks at the pharmacy for the otic solution for what is essentially vinegar. Not a doctor, just what I was told.

Or go to the pharmacist. There's a few products that you can drip in your ear for ear infections and you'll save a doctor visit.

Ibuprofen is a NSAID where 'AI' stands for anti-inflamatory. Reducing the inflamation probably helped draining your ear through the Eustachian tube.

I had strep every year around the holidays as a kid. It's a common, and easily treatable infection, but extremely dangerous left alone. It can go from bad to really bad, quickly, especially when it travels to the heart.

I believe that streptococcus bacterial infections can cause long term damage to the tonsils. It causes puts and holes, and people who have this often suffer from tonsil stones. You'll know if you've have them because every so often you'll cough one up and it causes halitosis.

Anyway, within the folds of the tonsils, streptococcus and other bacteria can survive, waiting for your immune system to become depressed, where it powers up again, making you ill.

Hence, you may think you have got rid of the infection, but it is just in stasis inside you.

This is one of the primary reasons that physicians recommend that you have your tonsils removed once you appear to have overly frequent repeats of strep throat.

Sadly, the removal of the tonsils often means that infections tend to end up further down the throat after having the tonsils removed, which being nearer to the lungs raises the risk of more serious illnesses later.

Yeah, so I learned. Didn't even have any of the more serious complications, but had nausea with it which led to dehydration and sleep deprivation. 72+ hours of that and I was in really rough shape, I'd guess not more than 12 hours from requiring hospitalization when I finally went to the doctor and got some drugs. Will not make that mistake again.

The danger to the heart is believed to be from the immune response to the strep, not the infection directly.

http://www.mayoclinic.org/diseases-conditions/rheumatic-feve...

Symptoms are the bodies response to infection. Regardless of what happens, because strep is present, then it occurs.

The point of my comment was that the infection does not travel to the heart. The immune response to the infection in the throat ends up having consequences elsewhere.

My son has to take antibiotics continuously because of an autoimmune reactions to strep (called PANDAS).

https://www.nimh.nih.gov/health/publications/pandas/index.sh...

Symptoms from the above link:

Presence of obsessive-compulsive disorder and/or a tic disorder Pediatric onset of symptoms (age 3 years to puberty) Episodic course of symptom severity (see information below) Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep or history of scarlet fever) Association with neurological abnormalities (physical hyperactivity, or unusual, jerky movements that are not in the child’s control) Very abrupt onset or worsening of symptoms

I wish it were easier to avoid their use

There are things you can do to reduce their need. A few things off the top of my head:

* Take shoes off at the front door (like Japan and a few other civilized places).

* Do not let the kids get on their beds wearing street clothes.

* Use hot baths and peroxide (in the ear) to help kill infection before it is so advanced that it requires antibiotics.

Of course, those things take work and are inconvenient, something many Americans seem allergic to. But if you really want to reduce antibiotic use, it absolutely can be done.

I read once a blog post [1] that I am constantly reminded of. The author had a problem that he frequently gets ear infection, because he rides his car with windows open (unscrewed to be honest). After seeking professional help and failed antibiotics treatment he went with one idea. He was warming his ear with halogen lamp by setting the light so it would go inside his ear. It worked.

I never had such infection so couldn't check validity of this myself.

[1] In Polish: http://frycz.pl.salon24.pl/335341,zapalenie-ucha-wewnetrzneg... Google Translate: https://translate.google.com/translate?sl=pl&tl=en&js=y&prev...

We already tick the other boxes, but may try the peroxide thing. I'd heard of it for cleaning ears, but not fighting infections. Thanks for the tip.

There is a lot more that you can do. Keep researching it. It gets easier the further you go.

I apologize if my original comment came across as snarky.

Best of luck.

terrible advice

too much hygiene weakens your immune system, exposure to common bacteria and fungi at a low level is good for it

and don't put anything in your ears! (except maybe salt-water), especially not peroxide which will cause irritation and maybe even scarring

Yep. Makes me wonder...

I'm overweight and asthmatic....and had frequent ear infections as a toddler.

I can relate! I had ear aches nearly every week or it seemed like it when I was a kid in the 70s it was really bad. I got to like the taste of the orange Aspirin tablets my mother would crush them into some sugar.

When my father stopped smoking all my ear aches disappeared.

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