Are antibiotics best?
Q: My two-year-old has a tendency to ear infections. Every time I take her to the GP we come away with a prescription for antibiotics. I can't help but feel that it can't be good for her but, on the other hand, I don't want her to suffer unnecessarily from earache, and am worried that if I don't take her to the doctor, her ears may be damaged in the future. What do you suggest?
A: This is a tricky question. A recent Dutch study has shown that if you give antibiotics to children under two with ear infections, their temperature will tend to last for two days rather than three days. But there seems to be no difference in the amount of time the children are in pain or cry, possibly because it's painkillers that help pain rather than antibiotics. Certainly, within 11 days, almost all children have fully recovered with no hearing loss or complications whether they have received anti-biotics or not. There's still lots we don't know about whether antibiotics help ear infections. When I suspected my two-year-old had an ear infection recently, I gave her paracetamol and didn't take her to our GP because I, like you, didn't really want her to have antibiotics. I have taken her subsequently just to have her eardrums and hearing checked to ensure there's been no damage.
Q: I'm 62 and have been on medication to control high blood pressure for more years than I care to remember. My blood pressure is always fine when I have it checked. I don't really get any side effects from it but I hate taking tablets. Do you think I could just stop them?
A: If you have had a heart attack or stroke in the past, you would be wise to stay on the medication because you would be at great risk of a recurrence if your blood pressure were to rise. Similarly, if you're diabetic, a heavy smoker or have high cholesterol and a strong family history of heart disease, you may not want to risk it. But if you're at low risk of heart disease and strokes, you may well be able to try coming off the medication. A recent study of 18 general practices in north-east England showed that 22% of people who came off their blood pressure medication were able to stay off it after three years. You can try to keep your blood pressure at a healthy level by losing excess weight and cutting down on salt and alcohol which all have a direct effect on blood pressure.
Q: I recently needed emergency contraception after an unexpectedly successful date. My GP said I could have the morning-after pill or have a coil fitted. I went for the morning-after pill and felt sick as a dog. If I need it again, should I go for the coil?
A: Emergency contraception is a godsend if you get caught short but can be a hassle to get hold of, especially since the UK doesn't allow pharmacists to sell morning-after pills over the counter. I'd try the new emergency contraceptive pill, Levonelle-2. It contains a progestogen hormone only so is like a massive dose of the mini-pill. It's 95% effective if taken within 24 hours of unprotected sex, and 85% effective if taken within three days. Levonelle-2 seems to cause less nausea and vomiting so may be worth a try. You can also have a coil fitted within five days of unprotected sex and the advantage is that it can remain in your womb for five years, if you wish, and provide long-term contraception. The disadvantages are that if you get a sexually transmitted infection there's a risk it will spread to the tubes, which can impair fertility, and that periods tend to be heavier and more painful. Despite that, I believe that coils are greatly underrated.
These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email email@example.com or write to her c/o the health editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.