New Guidelines for Ear Infections in Children

Doctors' group to recommend not using antibiotics

By Colette Bouchez
HealthScoutNews Reporter

SATURDAY, Feb. 15 (HealthScoutNews) -- Your 2-year-old wakes up in the middle of the night, crying and pulling on her ear. By morning, that ear is red and swollen and she's running a fever, too.

If you're like most parents, you bundle up your child and head straight to the pediatrician. Once there, you're probably not surprised to receive a diagnosis of acute otitis media -- or ear infection -- and a prescription for antibiotics, the most common treatment in use today.

However, that scenario may soon change.

A new set of guidelines on otitis media being drafted by a joint sub-committee of the American Academy of Pediatrics and the American Academy of Family Physicians promises to revolutionize the way ear infections are treated in children nationwide.

"Essentially the new guidelines will suggest what has already been stated by the Agency for Healthcare Research and Quality report and other literature -- namely, that most children over 2 years of age do get better without antibiotics," says Dr. Allan S. Lieberthal.

A pediatrician with the Kaiser Permanente Health System, Lieberthal is co-chairman of the joint subcommittee on otitis media.

Experts say younger children are more prone to ear infections, simply because of their still-immature physiology. Three out of four children experience otitis media by the time they're 3 years old, and ear infections are the most common illnesses in babies and young children, according to the National Institutes of Health.

"The tubes inside a child's ears are tiny, plus they lie in a horizontal position, which means they don't drain properly," explains Dr. Joseph Bernstein, director of pediatric otolaryngology at New York University Medical Center.

As time goes by, however, the tubes grow larger and assume a more vertical position, so that "by the time a child is 6 or 7 years old, ear infections are far less common," Bernstein says.

It's during the early years that infections frequently occur, and that has traditionally concerned both doctors and parents. One reason for the worry, experts say, was the commonly held fear that, unless treated with powerful antibiotics, these infections could result in severe and sometimes permanent damage to the ears.

However, while children under the age of 2 may still need medications to avoid complications, for the most part, "parents and physicians do not have to be as afraid of otitis media as we once were," Lieberthal says.

Studies now show that, generally, an ear infection rarely causes serious damage. If the infection doesn't get better on its own in the first couple of days, there's still plenty of time to treat with antibiotics -- without causing harm to the child.

"Certain children may require more aggressive care, but the doctor should be the one to make the determination as to what child needs antibiotics immediately and which one can safely wait it out to see if the infection goes away on its own because, in many instances, that is likely to be the case," Lieberthal says.

The sub-committee's report, expected to be released this spring, will reportedly follow treatment precedents already established in most European countries, where numerous large-scale studies have found antibiotics are often not necessary to clear an ear infection.

One reason for the interest in finding a new treatment regimen is due to the growing problem of antibiotic resistance. When antibiotics are prescribed too often, bacteria virtually reinvent themselves, becoming stronger and more resistant to treatment.

"With judicious use of antibiotics -- only using them when needed and using the appropriate antibiotic -- we hope to decrease the development of resistance. And [this was] most definitely the stimulus for this committee," Lieberthal says.

While only a doctor is qualified to decide if and when a child needs antibiotics, Bernstein says getting a correct diagnosis is also key.

"There are lots of other problems masquerading as ear infections, including allergies, or upper respiratory viral infections," says Bernstein. "But neither are true ear infections. They don't need, and won't respond to, antibiotics."

Bernstein also cautions parents to recognize that up to 50 percent of children will still have fluid in their ears four weeks after an ear infection has cleared. For 10 percent of children, fluid can remain for three months.

"But fluid alone, with no other symptoms, is not a sign of a recurring ear infection and does not require treatment," he says.

Symptoms of a true ear infection include pain, redness, swelling and fluid in the ear, along with fever and, sometimes, a temporary hearing problem, Bernstein says.

More information

February is Kids E.N.T. (Ears, Nose, Throat) Month.

To learn more about ear infections in children, visit the American Academy of Pediatrics or the American Academy of Family Physicians.