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New guidelines for ear infection treatment

26th February 2013

Child health experts in the United States have called on doctors to limit their prescription of antibiotics to children suffering from acute ear infections.

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Childhood ear problems can cause considerable distress, including pain and fever, and often result in a visit to the doctor, the American Academy of Pediatrics said in new guidelines published in the journal Pediatrics.

However, just because parents take their children to the doctor should not mean an automatic prescription for antibiotics, the guidelines say.

In the first update to the guidelines since 1994, the Academy asks doctors to distinguish carefully between inflammation of the middle ear and an acute ear infection.
Antibiotics are effective against the latter, but not against the former.
According to Farrel Buchinsky, director of pediatric otolaryngology at Allegheny General Hospital, it is harder than parents might think to diagnose an ear infection.
Even examination of a crying, wriggling child with an otoscope results in inconclusive evidence, and the view is often occluded by earwax.
Previously, acute onset of symptoms, fluid in the ear and inflammation were considered sufficient sign that an infection was present.
Now, doctors are being asked to prescribe antibiotics only in cases where at least some bulging of the eardrum is present, along with acute onset of symptoms and discharge.
Fluid is only considered evidence of an acute infection if it is seen in the middle ear, not just the outer ear.
According to co-author Allan Lieberthal, a professor of paediatrics at the University of Southern California, recent research has shown that the bulging of the eardrum is the key to diagnosing bacterial infections in the middle ear.
Antibiotics are not effective in the case of viral infections.
He said it was often hard for doctors presented with a suffering child not to hand out medicines as a first resort.
But medicine is not always the appropriate response, Lieberthal warned, adding that the over-diagnosis of ear infections would only fall if doctors stuck to the new guidelines.
He said it was a very hard sell to persuade a doctor that they should do nothing.
In a bid to cut down on the prescription of antibiotics, the Academy recommends treating pain and inflammation with over-the-counter medication like acetaminophen or ibuprofen in an age-appropriate manner.
Children should then remain under observation, and be given antibiotics only if there is no improvement over the next 2-3 days.
At least 70% of children get better without antibiotics, according to research conducted since 2004.

The guidelines also caution against long-term use of antibiotics in children with ear infections.

 


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