Don't Over-Treat Kids'
Earache, Doctors Urge

Two major physician groups jointly issued guidelines on Tuesday for the diagnosis and treatment of middle-ear infections, also called acute otitis media (AOM), in children.

A key feature of the guidelines is the option to just to keep an eye on certain children without using antibiotics.

These are the "first shared guidelines between the American Academy of Pediatrics and the American Academy of Family Physicians (AAFP) on ear infections," co-chairperson Dr. Theodore G. Ganiats, from the AAFP, stated.

"The main reason for generating these guidelines was the awareness of practices in Europe, which have been successful at allowing an option of observation," Ganiats, a family physician in San Diego, noted. "The growing bacterial resistance in the US" also suggested a need for guidelines, he added.

The guidelines, which stem from an exhaustive review of evidence-based research, feature a multistep algorithm that doctors can use to manage a suspected case of AOM. Based on the strength of evidence, each clinical suggestion was rated as no recommendation, option, recommendation, or strong recommendation.

The main conclusions were:

--In diagnosing AOM, physicians should confirm a history of acute onset, detect signs of middle ear fluid, and check for signs and symptoms of middle-ear inflammation (recommendation).

--If ear pain is present, clinicians should treat it (strong recommendation).

--Based on factors such as age and disease severity, certain children with uncomplicated AOM may be candidates for observation without the use of antibiotics (option).

--If antibiotics are to be used, start with amoxicillin (recommendation).

--If the initial management plan fails to work within 48 to 72 hours, physicians should reconsider the AOM diagnosis. Further treatment may involve starting antibiotics in children initially observed or changing antibiotics in patients already treated with such drugs (recommendation).

The guidelines also state that there is not enough evidence to support or discourage the use of complementary and alternative medicines for AOM.