You awaken suddenly, hearing your 3-year-old’s loud and persistent wails. When you enter the room, he is sitting up in bed, holding his ear and crying. Generations of parents have experienced this scene, and for most, there is little doubt that a middle ear infection (otitis media) is the cause. Your doctor’s advice, however, may be changing. In the United States, otitis media is the most common infection for which doctors prescribe antibiotics in children. However, as you probably know, in recent years, the medical community has had to increasingly deal with the issue of bacteria that cause infections becoming resistant to antibiotics. Moreover, it’s now known that bacteria are more likely to mutate and develop resistant strains if doctors prescribe antibiotics too often. Taking a proactive stance based on the latest research, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recently released new guidelines on the management of middle ear infections. The guidelines apply to a specific group of children: those ages 2 months to 12 years who are otherwise healthy, who have uncomplicated middle ear infections, and who have not had a previous infection or middle ear fluid in the past 30 days. The latest recommendations may surprise some parents. New studies show that approximately 80 percent of children with uncomplicated middle ear infections actually get better without antibiotics. In addition, research has demonstrated that children who are not immediately treated with antibiotics do not have a higher likelihood of developing a more serious illness. For these reasons, the guidelines propose an “observation option” for certain patients, in which parents would treat their children’s pain and start antibiotics only if symptoms have not improved in two to three days. While this is a new way of treating ear infections in the United States, in several European countries I ha is common practice. Daniel Neuspiel, M.D., of Beth Israel Pediatric Associates, says he has used the observation approach in selected patients. “Parents are very receptive to it; most are willing to give it a try,” Dr. Neuspiel reports. The observation approach is not for every child, however. Because children under 6 months are less likely to improve with observation only, the AAP and AAFP guidelines recommend that all children in this age group be treated with antibiotics. For children over 6 months of age, physicians should assess the severity of the illness. “Severe illness” is defined by moderate to severe ear pain and fever over 102 degrees. “Severely ill children should be treated with antibiotics, without an observation option,” the guidelines state. In children ages 6 months to 2 years with “non-severe illness”, observation can be used if the diagnosis is uncertain based on history or examination. In children over 2 years, even if the diagnosis is certain, parents and physicians may choose to observe the condition without antibiotics for two or three days. Although the new guidelines may frustrate some parents who are used to getting a prescription for antibiotics right away, it is important to note that there are ways to help prevent middle ear infections. Of course, many children will still get ear infections, and if this happens to your child, pay close attention to his/her fever and pain symptoms so you can help your doctor decide the best way to treat your child.
(Sidebox) Middle ear infections can be controlled by: —Breastfeeding for at least six months —Avoiding “bottle propping” —Eliminating pacifier use after 6 months of age —Reducing exposure to passive tobacco smoke JULIE SILVER, M.D., is an assistant professor at Harvard Medical School and the author of several books including the soon to be released ‘Chronic Pain and the Family’ (Harvard University Press). LINDA COZZENS, M.D., is a pediatrician in private practice who frequently writes about issues that pertain to improving the health of children.
