'Watchful Waiting' Proves Best for Ear Infections In Kids

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Academic Journal
Main Category: Ear, Nose and Throat
Also Included In: Pediatrics / Children's Health
Article Date: 25 Feb 2013 - 11:00 PST


Doctors are currently getting updated guidelines on diagnosing and treating the millions of children who are afflicted with middle-ear infections, one of the most standard bacterial illnesses kids encounter and one that is usually treated with antibiotics.

In 2004, the American Academy of Pediatrics (AAP) aimed to reduce the unnecessary use of antibiotics to prevent antibiotic-resistant bacteria. During that time, they suggested an observational approach was best before deciding to prescribe antibiotics for middle ear infections in kids ranging in age from six months to 12 years.

The new guidelines, released today and published in the journal Pediatrics, outline specific ways to pinpoint the best kids to observe and which ones should be treated immediately.

The guidelines recommend that children need antibiotics right away if they have what is defined as a severe ear infection:

• a fever of 102.2 degrees or higher or a great deal of pain
• infection in kids two years old or younger
• a ruptured ear drum with drainage

Richard Rosenfeld, professor and chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., and a co-author of the recommendations, believes that although these account for just a few cases, "we know from studies that they get the most benefit from an antibiotic right away. Kids without these symptoms tend to get well on their own and can be safely observed for a few days."

The observational approach does not mean doing nothing. These children should be treated with iburprofen or acetaminophen to relieve pain.

According to the authors, if the infection will improve on its own, it will do so within 72 hours. If they do not improve within that window, the child should then be given antibiotics.

In other research where the observation approach has been put into practice, two out of three children see results without an antibiotic.

Other factors can also contribute to ear pain, such as: a new molar in a baby's mouth, a sore throat or viral swelling, or a cold. Doctors are recommended to look at a child's ear drum to make a correct diagnosis.

Rosenfeld says, "If it's big and bulging, that's a sign of a middle-ear infection."

The new guidelines also mention:

• Several studies establish that exclusively breast-feeding for at least four months decreases the total number of ear infections.
• Decreasing exposure to passive tobacco smoke could lower ear infections during infancy.
• A choice for children who have recurrent acute middle-ear infections is ear-tube surgery - shown to be effective for those who still experience fluid between infections.

A study completed in 2010 and published in JAMA revealed that prescribing antibiotics for children's ear infection is only slightly more effective than doing nothing. Additionally, antibiotics caused side effects like diarrhea or a rash.

Written by Kelly Fitzgerald
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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