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Ear infection guidelines: Be patient

March 22, 2004|Jane E. Allen | Times Staff Writer

Children's painful middle ear infections account for about 30 million doctor visits each year and millions of antibiotic prescriptions, yet about 80% of these infections would go away without such drugs.

In an effort to stem the inappropriate use of antibiotics, the American Academy of Pediatrics has issued new treatment guidelines for treating acute otitis media in children through age 12. Overprescribing of the drugs is widely blamed for contributing to a worldwide increase in antibiotic resistance.

The first step in treating acute otitis media in most otherwise healthy kids should be relieving their pain with ibuprofen or acetaminophen in the first 24 hours, the doctors group says. That should be followed by watchful waiting.

Only if pain and symptoms don't go away in 48 to 72 hours should youngsters be reevaluated and then prescribed antibiotics.

This wait-and-see approach requires patience from parents and may lead to a second office visit that some parents could find inconvenient and expensive.

The rationale behind addressing pain first is that about 60% of kids feel better after a day, and antibiotics don't relieve pain in the first 24 hours anyway.

Dr. Allan S. Lieberthal, who helped draft the guidelines, acknowledged the potential burden for parents but suggested ways to avoid multiple visits. "Alternatives include a telephone conversation between parent and the doctor, or writing a prescription for an antibiotic and asking the parent only to fill it if fever and pain are not improving," he said.

Because some ear infections can lead to complications, the guidelines say antibiotics should be prescribed to children younger than 6 months who have diagnosed or suspected middle ear infections; kids 6 months to 2 years with suspected or confirmed infections and severe symptoms; and kids 2 to 12 with confirmed infections and severe symptoms.

"It's important to accurately diagnose an acute ear infection, which comes on suddenly, and not all abnormal-appearing ears are infected," said Lieberthal, a pediatrician with Kaiser Permanente in Panorama City.

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