News that links a life-saving pneumococcal vaccine for children to an antibiotic-resistant superbug has worried and confused parents across the country.

Does the vaccine give children the superbug and cause ear infections? No, say medical experts at The University of Texas Health Science Center Houston. Should parents with children under age 2 continue to vaccinate their children with the vaccine, called Prevnar?

“Oh definitely, to prevent a death and to prevent meningitis, the issue of whether to vaccinate your child with Prevnar is really a no-brainer,” says Lynnette Mazur, MD, professor of pediatrics at UT Medical School at Houston. “I trained in the time before the vaccine was available, when many children died of meningitis. Now we rarely see this type of meningitis in our patients.”

UT microbiologist Danielle Garsin, PhD, agrees with Mazur about the importance of vaccinations and encourages parents to look past the headlines, which may be misleading.

“They imply the vaccine is causing these antibiotic-resistant ear infections, which is not the case,” Garsin says, who is an assistant professor of microbiology and molecular genetics at UT Medical School. “Vaccines can not cause resistance to antibiotics. I am worried that the news encourages parents not to vaccinate their children.”

A superbug evolves

In September, doctors in New York reported discovering the first germ that is resistant to all drugs approved to treat childhood ear infections. The superbug is a strain of streptococcus (strep) bacteria, called 19A, not included in the pneumococcal vaccine Prevnar. The vaccine was introduced in 2000 to protect against bacteria that cause pneumonia, meningitis and deadly bloodstream infections.

Nine toddlers in Rochester, NY caught the bug caused by 19A bacteria. They developed ear infections that did not respond to two or more antibiotics, including high-dose amoxicillin and multiple shots of another drug. Many children required surgery with ear tubes to drain the excess fluid. Some recovered only after treatment with a newer, powerful antibiotic whose safety in children has not been established, according to news reports.

Scientists think that strains of strep bacteria not covered in the vaccine began to flourish once the strains covered in the vaccine were all but eliminated.

“Nature abhors a vacuum,” Garsin explains. “If you kill off some of the harmful bacteria, you leave an opening in which another strain can take advantage of that situation.”

Rebel germs

The superbug in Rochester is a frightening example of the growing problem of antibiotic resistance. The number of bacteria resistant to antibiotics has increased in the last decade and nearly all significant bacterial infections in the world are becoming resistant to common antibiotics, according to the Centers for Disease Control and Prevention (CDC).

Why are antibiotics losing their bite? We are using them too frequently and for the wrong reasons, experts say. Taking antibiotics kills sensitive bacteria, but resistant germs may remain and grow and multiply—a phenomenon called selective pressure. Continuous exposure to antibiotics may also cause bacteria that normally respond to antibiotics to mutate into hardier strains.

“When antibiotics are used extensively, bugs are under extreme pressure to survive. Any strains not affected by the antibiotic have a selective advantage and they take over,” Garsin says, who has experienced antibiotic resistance first hand. She recently contracted a MRSA (methicillin-resistant Staphylococcus aureus) infection while in the hospital following the birth of her baby.

We all contribute to antibiotic resistance every time we or our children don’t finish the entire course of prescribed treatment or we use antibiotics to treat a minor illness. And although doctors know better, they are more likely to prescribe antibiotics if asked. According to the CDC, a recent study showed that doctors prescribe antibiotics 65 percent of the time if they perceive parents expect them and 12 percent of the time if they feel parents do not expect them.

What can parents do?

Until researchers can develop new, more effective antibiotics, the best way to stem the spread of antibiotic resistance is to use the drugs only when necessary. That means knowing when antibiotics will work and when they won’t. Antibiotics only kill bacteria and will not treat illnesses caused by viruses such as colds or flu, coughs or bronchitis or sore throats of a viral origin. Also, many ear infections clear up on their own and don’t require antibiotics as a first line treatment. 

“Some doctors are delaying treatment with antibiotics to help prevent resistance,” Mazur says. “They may advise parents to hold off on antibiotic use and wait a couple of days before filling a prescription to see if it clears up.”

Mazur adds that the United States is one of the few countries that routinely treat ear infections with antibiotics. To prevent ear infections in children, she recommends breastfeeding infants six months or longer to encourage healthy immune systems and not smoking around children.

If an ear infection lasts longer than a week, parents should take their children to a doctor for treatment. Children who have frequent ear infections may need to see an ear, nose and throat specialist for a thorough exam and to discuss more long-term treatment methods, such as ear tubes.

Working one step ahead

As antibiotic resistance increases, researchers and drug companies are struggling to develop new vaccines and antibiotics that work against superbugs.

Wyeth, the manufacturer of Prevnar, is testing a second-generation vaccine to keep up with evolving strains of strep bacteria. The new vaccine may take an estimated two years to reach the market. Developing new antibiotics also takes time.

“Unfortunately, there are not many new antibiotics in the pipeline,” Garsin says. “We need to make developing new antibiotics a priority.”

UPDATED: 11-08-2007

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