Dr. Greene, my 9-month-old gets ear infections all the time. The problem is he won't take antibiotics. He can recognize medicine a mile off. Right now we are trying to give him Septra, but he completely refuses. What do you think of the new shot for ear infections? Does it really work? What are the side effects?

The promotion of the "new" shot for ear infections reminds me of an early sunny scene in a horror film: a happy, unsuspecting family is enjoying a beautiful afternoon together in the backyard. Everything looks wonderful, but you know something bad is just around the corner.

In January 1998, the United States Food and Drug Administration (FDA) approved Rocephin (ceftriaxone) as the first single-dose injection for the treatment of ear infections. News stories heralded the safety, effectiveness, and especially the ease of this new treatment. I have spoken with many parents (and doctors) who were very excited about the development.

Developments in the treatment of ear infections are commonly welcomed. This is because ear infections are responsible for an astounding number of doctor’s visits. In 2000, ear infections accounted for 16 million doctor’s visits a year (Pediatrics, May 2004). And more antibiotics are given to children for ear infections than for any other reason.

Even though shots are no fun, neither is battling with children over taking medicine two, or even three, times a day for 10 days. The manufacturers of Rocephin conducted a survey of parents and found that more than 67 percent of them preferred giving their children a single-dose shot compared with any multi-dose, multi-day course of oral antibiotics. They also found that 90 percent of parents who had actually used Rocephin for their children would choose it again over oral antibiotics in the future. It makes sense that parents like it.

A physician whom I respect as one of the top ear infection experts hails the single shot of Rocephin as offering "a new alternative when standard multi-day, multi-dose oral therapy is problematic == for example, for children in daycare, or when the family is traveling."

Does Rocephin work?

Even though Rocephin is only recently in the news, it is not a new antibiotic. For 13 years it has been the most common injectable antibiotic used in doctors' offices. It has been a real lifesaver! This very effective, very broad-spectrum antibiotic is the one we often turn to for seriously ill children (e.g. with sepsis or meningitis, which can be life-threatening), or when the bacteria are resistant to oral antibiotics.

Most doctors I know are pretty objective about the treatments they recommend, but I should mention that there is a potential conflict of interest regarding Rocephin. Doctors are not paid for the oral antibiotics they prescribe, but in many instances do receive a small direct payment for injections. These payments could add up if this seldom-used, safety-net injection is used for everyday ear infections. The pharmaceutical giant, of course, stands to make huge sums of money by now positioning their product in this way. (Note: most drug patents expire after 17 years).

Is one shot enough to get rid of an ear infection?

Although one early study found a single dose of Rocephin to be less effective than oral antibiotics, later studies have found it to be equally effective. Researchers in the Emergency Room at Riverside General Hospital in southern California found one shot of Rocephin to be equally effective to 10 days of amoxicillin given 3 times a day (Pediatrics, Jan 1993). Yes, it works.