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The problem, says Dr. Breitzer, is complicated by the fact that the three bacterial strains that most commonly cause AOM are becoming more resistant to antibiotics. This is critical at a time when nearly half the pediatricians recently surveyed said that parents pressure them to give antibiotics in diseases where they are not indicated, and a third of them comply “at least occasionally.” Over-prescribing antibiotics has been tied to this increase in resistance.
“Healthy Ears” is a multi-pronged program that works with physicians, children and their parents, and community organizations to thwart AOM. Targeting children four years of age and younger, it includes educational mailings to parents, presentations at child care centers and schools, and free access to a nurse to answer questions about ear infections.
Dr. Breitzer notes that kids most likely to develop AOM include those from homes where someone smokes, those bottle-fed (especially those who drink horizontally), those in daycare, and those using pacifiers after ten months of age.
Working with physicians, Dr. Breitzer recommends a careful examination of the ear using pneumatic otoscopy, an appropriate course of antibiotics, good patient education on AOM, careful follow-up, the use of heptavalent S. pneumonia vaccine and yearly influenza vaccinations.
Dr. Breitzer is an advocate of minimizing the use of pressure equalizing (PE) tubes in the ears, since studies show that by age four there is no difference in cognition, speech and hearing between those who received it based upon the current recommendations and those who receive them later if necessary.
Recent data would indicate “Healthy Ears” is having a positive impact. PHP of Mid-Michigan patients under four years of age have a decreased utilization of PE tubes while the rest of Michigan and nation has shown an increased utilization.
Working with Dr. Breitzer on the project have been Lee Garner, R.N., Jane Miller, R.N., M.S.N., and Olga Dazzo, chief executive officer of PHP.
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