Physicians are getting new guidance on diagnosing and treating the millions of kids who suffer through painful middle-ear infections, the most common bacterial illness in children and the one most often treated with antibiotics.
Reducing the overuse of unnecessary antibiotics, the leading cause of antibiotic-resistant bacteria was a key factor in the American Academy of Pediatrics' 2004 recommendation that watchful waiting or an observational approach is best before prescribing antibiotic treatment for acute otitis media in kids ages 6 months to 12 years.
The academy's new guidelines, published today in Pediatrics, "really attempt to clarify who are the best kids to observe and who are the best to treat right away," says Richard Rosenfeld, professor and chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., and a co-author of the recommendations.
According to the guidelines, children need immediate antibiotics if they have a severe ear infection (defined as either a fever of 102.2 degrees or higher or significant pain); a ruptured ear drum with drainage; or an infection in both ears for kids 2 or younger.
These account for fewer cases, but "we know from studies that they get the most benefit from an antibiotic right away," says Rosenfeld. "Kids without these symptoms tend to get well on their own and can be safely observed for a few days."
Observation doesn't mean sitting back and doing nothing, however. Ibuprofen or acetaminophen should be given to relieve pain. "If it's going to improve, it will happen in 72 hours. If a child's symptoms get worse or don't improve in that time, they should be given antibiotics," he says. In studies where the observational option has been offered, two out of three kids get better without an antibiotic, he adds.
Rosenfeld notes that other conditions, such as a new molar in a toddler's mouth, a cold, sore throat or viral inflammation can all result in ear pain. Physicians are encouraged to examine the child's ear drum to make an accurate diagnosis. "If it's big and bulging, that's a sign of a middle-ear infection," he says.
The new recommendations also note that:
-- Multiple studies provide strong evidence that exclusively breast-feeding for a minimum of four months reduces overall episodes of ear infections.
-- Eliminating exposure to passive tobacco smoke may reduce ear infections during infancy.
-- Ear-tube surgery is an option for kids with recurrent acute middle-ear infections; it has been shown effective, especially for those who hold on to fluid between infections.