Treatment changes for kids' ear aches
Antibiotics suggested only in with severe pain, symptoms
Guidelines for diagnosing and treating ear infections are changing and the result may mean fewer prescriptions for antibiotics.
The American Academy of Pediatrics (AAP) on Monday released the new guidelines for diagnosing and managing acute otitis media (AOM), the most common form of ear infections.
Going forward, pediatricians should only diagnose acute ear infections if the child's eardrum is moderately to severely bulging or if there is discharge leaking from the ear, according to the recommendations. They may diagnose a middle ear infection if the child's ear drum is mildly bulging and there is recent onset of pain or intense redness.
Doctors should only prescribe antibiotics in children 6 months and older if there are severe signs or symptoms, which the academy defines as a temperature of 102.2 degrees or higher, or severe pain or if young children between 6 and 23 months have ear infections in both ears.
"Studies have shown that bulging (of the eardrum) is the best criteria for diagnosing an ear infection." says Dr. Allan Lieberthal, lead author of the guidelines and clinical professor of pediatrics at the Keck School of Medicine at the University of Southern California.
If a toddler or baby (older than 6 months) has an ear infection in only one ear, then antibiotics should be an option as well as simply watching the child to see if things clear up on their own. If observation is chosen and the child not better within 72 hours, then it's time to consider antibiotics again, experts say.
The key message is that parents should not be expecting antibiotics each time, Lieberthal says.
Observation has been proven to be very effective and has been recommended since the last time the AAP updated its guidelines back in 2004, says Lieberthal. But the previous guidelines recommended prescribing antibiotics under a definition of "uncertain diagnosis." That, says Lieberthal, no longer exists. The new guidelines very specifically lay out when and when not to diagnose and prescribe antibiotics for ear infections.
The guidelines are for uncomplicated acute otitis media in children aged 6 months to 12 years who are otherwise healthy and do not have recurrent ear infections.
AOM is a common condition where the middle ear is inflamed. Recurrence is defined by three separate infections in six months, or four in 12 months, with at least one of those infections occurring in the past six months.
"If a parent would not take their child to the doctor for a common cold, the parent does not need to take the child to the doctor worrying about an ear infection, except in those two instances (high fever and severe pain)," says Lieberthal. But, he notes, "even a child with that high a fever and severe pain may not have an ear infection."
That's because ear pain is common in young children and may be caused by teething, a cold, a sore throat, jaw problems, or an ear infection, says Dr. Rich Rosenfeld, co-author of the guidelines and professor and chairman of otolaryngology at SUNY Downstate in New York. "You can't tell which one it is without seeing your doctor, but since most of these go away on their own, it isn't always necessary."
Rosenfeld tells parents it's time to take their child to the doctor if any of the following are present: "severe ear pain, persistent ear pain that lasts more than two days, temperature more than 102.2 degrees or new onset of drainage (pus or blood) from the ear canal."
The goal here is to only use antibiotics when absolutely necessary and when it will actually help.
"There is also tremendous overuse of antibiotics," says Lieberthal. "Antibiotics can cause side effects to the child such as diarrhea (and) resistant bacteria; it also hurts the community because there are more bacteria that have become resistant to antibiotics."
Antibiotics treat bacterial infections; they don't reduce pain. Over-the-counter pain medication can be helpful for that.
The question that still needs to be answered is how parents and pediatricians will adapt to the new guidelines.
"In my and many doctors' experience, patients are not requesting antibiotics and would welcome not getting them," Lieberthal says. "So parents in many cases aren't the driving force."
He acknowledges that is can be very difficult to change doctors' habits. "We hope the doctors take (the new guidelines) to heart."
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