Kids With Ear Infections May Not Need Antibiotics, New Guidelines Say

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Young children with ear infections don't necessarily need antibiotic treatment right away. In fact, they may not need the medication at all, according to new guidelines from an influential group of doctors.

Children ages 6 months to 2 years with an infection in one ear who don't have a high fever, severe pain or other complications can be watched for 48 hours without antibiotic treatment to see if the infection gets worse, the guidelines say. The same watching period applies to older children with a mild infection in one or both ears.

The new guidelines, from the American Academy of Pediatrics, are intended to reduce unnecessary use of antibiotics. While previous guidelines from the AAP proposed a watching period for older children with mild ear infections, the new guidelines are more specific about how to diagnose infections and include younger children.

The guidelines specifically discuss recommendations for acute otitis media, or infections or inflammation of the middle ear, the most common type of ear infection, and the most common reason U.S. kids receive antibiotics, the AAP says. The AAP also recommends against the use of antibiotics to prevent future ear infections in kids who frequently get such infections.

"We do believe there's overuse of antibiotics in the community," said Dr. Andres Orjuela, an ear, nose and throat specialist at Miami Children's Hospital, who was not involved in developing the new recommendations.  The new guidelines are a helpful tool for instructing physicians on how to go about diagnosing and treating ear infections, Orjuela said.

Studies show that often, kids with a mild ear infectios will get better without antibiotics within a few days, and delaying treatment doesn’t have repercussions for the child, Orjuela said. Painkillers such as ibuprofen or acetaminophen can help with pain.

However, some kids will need antibiotics, including young children who have an infection in both ears, and all kids whose symptoms persist for more than 48 hours. Doctors who take a "wait and see" approach to treating ear infections need to be sure the child can be reevaluated within a few days, and provide treatment if necessary, Orjuela said.

A 2007 study found that physicians were hesitant to delay the use of antibiotics for ear infections, most commonly because they said parents were reluctant to accept this approach. The new guidelines say the decision about whether or not to delay the use of antibiotics in kids with a mild ear infection should be made in partnership with the parents. The 2007 study suggested providing parents with antibiotics to give to their children only if their symptoms didn't go away, but noted that this strategy places more responsibility in the hands of parents and may not be suitable for everyone.

The new recommendations are published today (Feb. 25) in the journal Pediatrics.

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