Ear Infection? Antibiotics
May Not Be the Best Choice
Your toddler's been up half the night,
crying and tugging on his ear, and by now you know the routine.
Call the doctor, get a prescription for an antibiotic, race to the
pharmacy and get him on the road to recovery from that ear infection.
Not so fast. Until recently, that
scenario was common. Your pediatrician would probably prescribe
an antibiotic ASAP. But under new guidelines, your doctor may suggest
waiting a while -- and even skipping antibiotics altogether.
Concern about the rising rate of
antibiotic use, leading to resistance of the germs that cause middle
ear infections, has prompted the new guidelines encouraging lower
use of antibiotics.
Middle ear infection -- called acute
otitis media -- is the most common bacterial illness in children
and the one most commonly treated with antibiotics. More than five
million cases of acute middle ear infections occur annually in the
United States, according to the American Academy of Pediatrics.
And more than 10 million antibiotic prescriptions are written each
year to manage those infections.
But that number will hopefully decline,
without an adverse effect on children's health, in the wake of the
new guidelines, issued earlier this year by the American Academy
of Pediatrics and the American Academy of Family Physicians.
While the goal is to cut down on
unneeded antibiotics, "this is not a recommendation not to
give antibiotics," said Dr. Allan Lieberthal, a pediatrician at
Kaiser Permanente in Panorama City, Calif., and lead author of the
Rather, the goal is to postpone or
sometimes eliminate the use of antibiotics. Parents should also
understand the guidelines cover basically healthy children only.
"The key part of this is, it is for selected children," Lieberthal
The guidelines are primarily intended
for children 2 years of age or older who aren't seriously ill or
have some underlying condition, Lieberthal said. Excluded from the
guidelines are children with chronic illnesses that affect the ear.
This would include, for instance, children born with a cleft palate,
which predisposes them to chronic middle ear infections. Also excluded
are children with genetic conditions such as Down syndrome, immune
system disorders and hearing-impaired children with cochlear implants,
There are three key components to
the new guidelines, according to Lieberthal. "The first is accurate
diagnosis. The second is treatment of pain," he said.
Then, the doctor must decide if antibiotics
are needed at all. "Selected children with ear infections may not
need antibiotics," said Lieberthal. "More than 80 percent of the
children who meet the guideline definition [of those who might not
need antibiotics] get better without antibiotics."
Here's what the new guidelines recommend:
- Accurately diagnosing acute otitis
media and differentiating it from otitis media with effusion (middle
ear fluid), which requires different management.
- Relieving pain, especially in the
first 24 hours, with ibuprofen or acetaminophen.
- Giving parents of healthy children
the option of fighting the infection on their own for 48 to 72
hours, then starting antibiotics if they do not improve.
- Encouraging families to prevent
acute otitis media by taking steps to reduce risk factors. For
babies and infants this includes breastfeeding for at least six
months, and eliminating exposure to passive tobacco smoke.
- If antibiotic treatment is agreed
upon, the doctor should prescribe amoxicillin for most children.
It's also crucial, Lieberthal said,
for parents to observe the child closely and to keep the doctor
informed about their child's condition, so antibiotics can be prescribed
Another expert, Dr. Dennis Woo, chairman
of pediatrics at Santa Monica-UCLA Medical Center in California,
said the new guidelines "give credibility to what a lot of us were
Antibiotics should still be prescribed
under certain conditions, according to the guidelines. For instance,
children 6 months old or younger should receive the drugs is they
have a diagnosed or suspected middle ear infection.
For children age 6 months to two
years, antibiotics should still be prescribed if the diagnosis is
a suspected or certain middle ear infection with severe symptoms.
If the symptoms aren't severe and the diagnosis is suspected or
uncertain middle ear infection, observation is an option.
For children ages 2 to 12 years,
antibiotic treatment is recommended for certain middle ear infections
with severe symptoms, and observation is an option for suspected
or non-severe middle ear infection without severe symptoms.
Putting the guidelines into operation
may work best in a practice setting where the doctor knows the families
and the parents understand the importance of keeping the doctor
posted on the child's status, Woo said.
Both Woo and Lieberthal agreed there
is no danger to postponing antibiotics in healthy children if they
are watched closely.
Reference Source 101