Q-Our family has been living in Spain since November 2000. Both our daughters are unvaccinated (Ella, two, was breastfed and Allegra, one, is still breastfeeding) and, until now, had not received any antibiotics at all. We have treated both homoeopathically with a minimal use of Calpoltype stuff and let fevers take their natural course.

Ella developed a mild case of chickenpox about a week ago. Allegra, who has not caught chickenpox, has been touching her ear for a couple of weeks and green, waxy stuff sometimes comes out of it.

After trying homoeopathic remedies, we eventually decided to give her one of the antibiotics recommended by the GP. At first, we gave her Augmentin orally for 10 days twice a day, but it didn't work. She was then given cefuroxime for 10 days plus ciprofloxacin drops, which was squeezed into her ear for seven days. After this didn't work, we were referred to an ear specialist, who noted that her left ear had otitis media (middle ear infection) with pus and swelling, representing a medium degree of worry. The right ear just had a little swelling, and was less worrying than the left one. This specialist has said that the previous antibiotics should have worked, but since they haven't, he now wants to put her on a stronger antibiotic called azithromycin as well as carrying on with the ciprofloxacin drops.

Allegra is clearly uncomfortable and is not sleeping. Both girls also have harsh rasping coughs. The GP seemed to think that Ella had laryngitis. She is also complaining about pain in her throat, but is otherwise her usual bouyant self. Can you please comment on the antibiotics and offer any other suggestions so we can then decide what to do? AB, via e-mail.....

A-Allegra is suffering from a middle ear infection, which is extremely common in young children. Increasingly, doctors are taking a conservative approach to ear infection by letting Nature take its course and simply offering pain relief. Unfortunately, there remains a contingent of doctors who resort to nuclear warfare to fight this relatively benign problem, and end up making the problem worse. The medical literature is awash with evidence that doing nothing is as good as bombarding a child with antibiotics, lancing the eardrum or lancing plus antibiotics. In fact, the only difference is that children not given antibiotics have fewer recurrences (Lancet, 1981; ii: 883-7).

And what a cocktail has been thrown at Allegra! Augmentin is the trade name for amoxycillin, a common or garden antibiotic used to treat ear, sinus and bladder infections. When that didn't work, your doctor tried cefuroxime axetil an antibiotic belonging to the cephalosporin family

which is commonly used to treat bronchitis, ear, urinary tract and skin infections. It can also cause fever, convulsions, severe abdominal or stomach cramps, skin rash, joint pain, unusual bleeding or bruising, a decrease in urinary output and low blood pressure.

Ciprofloxacin, one of the fluoroquinolones, is usually given to those patients who are allergic to bog standard antibiotics such as amoxycillin or those whose infection has proved antibiotic resistant thus far. This drug is used to treat such infections as those of the urinary tract, osteomyelitis, infectious diarrhoea and gonorrhoea. This family of drugs is decidedly heavy duty and comes with a host of side effects. According to the Health Research Group, the fluoroquinolones can cause central nervous system problems, collapse of the circulatory system and psychosis. Severe even fatal allergic reactions have been recorded with this category of drugs after just a single dose.

Indeed, so powerful is this drug that the Journal of the American Medical Association says that cipro floxacin is often inappropriately used. The journal also cautions that it should not be used for sinus or ear infections (J Am Med Assoc, 1990; 264; 1438-40).

Since neither of these two powerful drugs has done the trick, the ear specialist appears to be working his way through the medicine chest. Azithromycin belongs to the same family of drugs as erythromycin, which is considered among the safer forms of antibiotics. But, as it has about the same effectiveness as amoxicillin, it may not work either.

The problem with blasting anyone particularly a one year old with four different antibiotics in a row is that it is likely that all the beneficial bacteria in her gut have been virtually wiped out, paving the way for an overgrowth of Candida albicans (a yeast) infection in the gut or vagina.

As your daughter's ear doesn't seem to be responding to the medical profession's potent arsenal so far, it's likely that the problem isn't bacteria per se. Indeed, one study shows that repeated courses of antibiotics might eliminate bacteria, but not the fluid, suggesting that it is coming from something else (Jung TTK et al, in Lim DJ et al (eds), Recent Advances in Otitis Media with Effusion, Philadelphia: BC Decker, 1984). Children who are allergic to something are twice as likely to have otitis media with effusion (earache with secretions of pus) (Laryngoscope, 1967; 77: 636).

The most common culprits, according to one study of 1000 patients, are cow's milk and other dairy produce, cocoa, cola, cane sugar, grains like wheat, citrus fruits, eggs and nuts (Speer F, Food Allergy, Littleton, Mass: PSG Publishing Co, 1983).

Since Allegra is breastfeeding, she may be reacting to something in her mother's diet. One way to find out is for your wife to undergo an exclusion diet and keep a food diary to isolate the food factor most likely to be causing the problem. If Allegra is also eating solids, you might try eliminating foods one at a time to see if her condition clears up. If you have started giving her cow's milk or cow's milk products, you might wish to switch to goat's milk (if you can get it in Spain) or eliminate milk products altogether to see if that clears the condition. Goat's milk is usually far more digestible. Also, you haven't mentioned if you are mixed feeding her. If Allegra is being given formula, you might also switch to goat's milk formula to see if that helps.

You'll need to check if Allegra has a mouth or vaginal yeast infection. See our issue on Candida (WDDTY vol 9 no 9) for suggestions on how to treat it. To repopulate her gut, you'll need to give her Lactobacillus acidophilus. BioCare has an excellent L. acidophilus preparation for babies called Banana Acidophilus, flavoured with natural banana, and Solgar does one called ABCdophilus.

Finally, our panel member Harald Gaier points out that, given that both Ella and Allegra are suffering from persistent rasping coughs, this may well be an indication of an allergic response to something in the environment, such as a new pet, so this is also worth looking into. To help you identify a possible cause, consulting a practitioner may prove useful.