February 26, 2013
Children's doctors have new guidelines to help them diagnose and treat children's ear infections. The American Academy of Pediatrics issued the guidelines February 25. One goal is to reduce the use of antibiotics, which often are not needed. The guidelines were last updated in 2004. The new ones include the results of research done since then. They describe a more precise way to diagnose an ear infection. And for the first time they say it's OK sometimes to wait before giving antibiotics to children ages 6 to 23 months. Immediate antibiotics are still recommended for children with severe infections or high fever. They also should be given when kids don't get better within 48 to 72 hours, the guidelines say. Doctors are urged to give medicine for pain, especially during the waiting period. Some doctors now prescribe antibiotics for prevention to children who get frequent ear infections. The guidelines do not recommend this. The journal Pediatrics published the guidelines. HealthDay News wrote about them.
By Claire McCarthy, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
When it comes to ear infections, antibiotics aren't always a good idea. This was the whole reason the American Academy of Pediatrics (AAP) issued a policy guideline in 2004.
Many ear infections are caused by viruses. They don't need antibiotics, which kill bacteria, not viruses. Also, many pediatricians diagnose an infection when the ear is not infected but only contains fluid. This is called otitis media with effusion, or OME.
Ear infections are the most common condition for which antibiotics are prescribed in the United States. The hope with the 2004 guidelines was to decrease overprescribing of antibiotics. Prescribing has gone down somewhat, but not a lot. And not only that, surveys have shown that doctors are not reliably following the guidelines.
So the AAP has issued the guidelines again -- with a few things added and clarified. Here's what the guidelines are asking doctors to do:
What Changes Can I Make Now?
If you take your child to the doctor with ear pain, talk to your doctor about these guidelines. Make sure he or she is following them. Most importantly, be willing to leave without a prescription for an antibiotic. Doctors can follow the guidelines more easily if parents don't ask for or expect antibiotics for every earache.
What Can I Expect Looking to the Future?
We are seeing more and more bacterial infections that don't respond to antibiotics. The main reason is that we are using too many of them. If we want our antibiotics to work, we need to use them only when absolutely necessary -- and we need to use the one most suited to the infection.
Guidelines like these can help us do just that -- if doctors and patients follow them.