New Guidelines for Ear Infections

When a child is in pain and crying, a loving parent wants nothing more than to make the pain go away.  Ear infections can be very painful and often a parent will request antibiotics to treat the infection from their pediatrician or family doctor.

The American Academy of Pediatrics (AAP) has issued new guidelines for identifying and treating childhood ear infections and would like to see fewer antibiotics prescribed.

The guidelines more clearly define the signs and symptoms that indicate an infection that needs treatment. They also encourage more observation, with follow-ups, instead of antibiotics. This would also include some children under the age of two. Most children with ear infections get well on their own and can be safely monitored for a few days.

For children with recurrent infections, the guidelines advise physicians and parents on when it is time to see a specialist.

"Between a more accurate diagnosis and the use of observation, we think we can greatly decrease the use of antibiotics," said the lead author of the new guidelines, Dr. Allan Lieberthal, a pediatrician at Kaiser Permanente Panorama City, in Los Angeles, and a clinical professor of pediatrics at the Keck School of Medicine at the University of Southern California.

The guidelines say that there are definitely times when antibiotics should be prescribed such as when children have a severe ear infection. Severe is defined as when a child has either a fever of 102.2 degrees or higher or is in significant pain. He or she has a ruptured ear drum with drainage, or an infection in both ears for kids two years or younger.  These account for fewer cases but studies have shown that children benefit from antibiotics given right away.

It's been since 2004 since the last set of guidelines were issued. Those guidelines stimulated new research that has provided evidence for the new AAP guidelines that will appear in the March issue of Pediatrics.

Lieberthal said the biggest change is the definition of the diagnosis itself. Experts say that the new definition is more precise. Because of the different stages of ear infections, diagnosis can be tricky.

The AAP offers detailed treatment suggestions that encourage observation with close follow-ups as long as the child is not having severe symptoms, but leaves it up to the discretion of the physician whether or not to prescribe antibiotics.  Previous guidelines recommended that antibiotics be prescribed for children under two with ear infections.

Pain management is also an important component of the new guidelines. Antibiotics can take up to 2 days before they start to improve symptoms, so if a child has fever or pain they should be given pain relieving or fever reducing medications.

The new guidelines also state that children, even those with recurrent infections, shouldn't be on long-term daily antibiotics to try to prevent infections from occurring. Long-term antibiotic use has its own downfall. Children can develop a rash and diarrhea (causing dehydration.) The biggest concern is that the child will build up immunity to the antibiotic, making it ineffective over time.

When children have recurrent ear infections they should be referred to an ear, nose and throat specialist. Recurrent is defined as children who have three or more ear infections in a six-month period, or four or more infections in a one-year period (with at least one infection occurring in the previous six months.)

The new guidelines also recommend staying current on your child's vaccine schedule, especially the pneumococcal conjugate vaccine (PCV), and the flu shot. "Studies show that anything that decreases viral infection will decrease the incidence of ear infections," Lieberthal said.

Many parents are beginning to see the logic of not over-using antibiotics, but some are still unaware of the dangers. Physicians may now be more assertive about watchful waiting and follow-ups when a child's ear infection isn't severe. That may not comfort the parent of a crying child in pain, but it may be the best approach for the child in the long run.

Sources: Serena Gordon

Michelle Healy

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