Back from the doctor - more questions for you

[klmama]

The child I was so concerned about, with the apparent pink eye, the doctor isn't very concerned about. Warm compresses, with an eye drop prescription to be filled in a few days if the redness doesn't clear up by then. He says it isn't very pink, and since the other cold symptoms are all gone, better to see if it clears up on its own. Okay, fine.

The child I wasn't at all concerned about, with just a mild cold, the doctor checked anyway, and that one has an ear infection that has blistered. He was amazed this dc wasn't screaming in agony. Nope, dc is perfectly cheerful and full of energy, as always, just a bit miffed to have a runny nose. Doctor recommends amoxicillin for 5 days, and to call in 3 if no improvement in cold symptoms (since there is no apparent ear pain). Which leads me to my questions (since I forgot to ask the doctor and since he doesn't put much stock in "anecdotal" evidence):

1. Is 5 days of amoxicillin enough to cause problems with tooth enamel development or is it the recurrent use of antibiotics that is the problem?

2. I keep reading about recurring ear infections leading to behavioral and attention issues. This child is unusually active, although attention seems fine, but since there were no obvious symptoms of ear infection this time, I suspect it's happened before and I didn't know it. I'm wondering if it's the infection that's really the problem, or is it the use of antibiotics that causes the behavioral issues?

[RoughCollie]

Here's a link to what looks like the first article about it, Association of Amoxicillin Use During Early Childhood With Developmental Tooth Enamel Defects:

http://archpedi.ama-assn.org/cgi/content/full/159/10/943?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=amoxicillin&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT


There were other articles at the Archives of Pediatrics and Adolescent Medicine, but I couldn't access them. The link is here, though:

http://archpedi.ama-assn.org/cgi/search?fulltext=Amoxicillin&quicksearch_submit.x=6&quicksearch_submit.y=10

Here's a link from the American Dental Association with information about it:

http://gsa.ada.org/search?q=Amoxicillin+&site=ADAorg_Collection&client=ADAorg_FrontEnd&proxystylesheet=ADAorg_FrontEnd&output=xml_no_dtd&proxyreload=1&btnG.x=29&btnG.y=12&btnG=Search

Here's a link to Science Daily's article about it, Amoxicillin Use During Infancy May Be Linked To Tooth Enamel Defects:

http://www.sciencedaily.com/releases/2005/10/051007094657.htm

[Claire]

My understanding is that amoxicillin does not cause problems with tooth enamel. Not sure, but I think it's erythromycin that does that.

Behavioral problems are not associated with antibiotics, as far as I know. Behavioral problems are associated with repeated and/or undiagnosed ear infections, though. Chronic ear infection can interfere with vestibular system development (balance, rhythm, timing) and sensory integration, which can manifest in sensory-seeking activities and hyperactivity. Also, fluid behind the eardrum makes speech muffled so a child with this problem may not be as responsive to verbal direction, may have delayed acquisition of language, and may also be inappropriately punished for "not paying attention", "not listening", "not following directions", etc.

[Claire]

Okay, after reading RoughCollie's articles I have to take that back about amoxicillin. However, the problem seems to be with using it during early infancy. Here is an excerpt from the conclusion in the first article:

The period of amoxicillin use important to fluorosis on early-erupting permanent teeth was found to be within the first year of life, particularly the first 6 months.

[nmoira]

Not a direct answer to either of your questions, but my family doctor does the "wait couple days and then start the antibiotics" approach. If your child isn't in distress, I personally wouldn't start antibiotics.