Director, Emergency Services, Bikur Cholim Hospital
It is only natural that medical treatments change as research
is done and statistical studies continue. One example is the
new trend in treating ear infections.
The literature says that most pediatricians — and even
ear, nose and throat specialists — can not agree on
this disease. If there is pus behind the eardrum it is easy
to diagnose, but many times this is not enough to call it a
bacterial illness. Many kids got tubes placed in their ears
for this disease in the past, but recent research — not
yet conclusive — shows that tubes may damage ears. I
can only recommend that you have a very good ENT doctor
before you take this step.
Make sure your doctor doesn't jump to diagnose an ear
infection where fever is present without checking out other,
more serious possibilities.
Throats are a different story. Strep is a common problem, but
many people are carriers, making it hard to eradicate.
Penicillin remains the drug of choice. The tried and true
"Center" criteria are a good way to decide on treatment.
Test for strep:
1) Is there white plaque on the tonsils?
2) Is there fever?
3) Are the lymph nodes felt in the neck?
4) Does the patient lack a cough or runny nose?
If the answer to all four is "yes," start antibiotics,
without waiting for results of a throat culture.
If one or less is "yes," it is not likely to be strep.
If two or three signs are present, test for strep, realizing
that cultures are not perfect and miss a lot.
Patients who are allergic to penicillin should take
clindamycin, a much better drug than erythomycin or
roxothyromycin. Gargling with an antiseptic mouthwash may
also help.
Do not run to extract tonsils unless there are repeated bouts
of strep in a short period of time. A penicillin shot is a
good idea, since it works without the fuss of taking pills.
While many Americans let strep run its course, we still see
rheumatic heart disease in Israel. This occurs when one form
of strep attacks the heart, so it is best to take the full
course of antibiotics when prescribed. Write me in care of
the Yated.
