MONDAY, Feb. 25 (HealthDay News) -- The American Academy of
Pediatrics has issued new guidelines for identifying and treating a
common childhood ailment that can cause a lot of misery -- the ear
In the guidelines released Monday, the pediatrics group more
clearly defines the signs and symptoms that indicate an infection
that might need treatment. They also encourage observation with
close follow-up instead of antibiotic treatment for many children,
including some under the age of 2 years. And, for parents of
children with recurrent infections, the new guidelines advise
physicians and parents when it's time to see a specialist.
"Between a more accurate diagnosis and the use of observation, we think we can greatly decrease the use of antibiotics," said the lead author of the new guidelines, Dr. Allan Lieberthal, a pediatrician at Kaiser Permanente Panorama City, in Los Angeles, and a clinical professor of pediatrics at the Keck School of Medicine at the University of Southern California.
The last set of guidelines was issued in 2004. Lieberthal said
those stimulated a lot of new research, which provided additional
evidence for the current American Academy of Pediatrics (AAP)
guidelines appearing in the March issue of
Lieberthal said the biggest change in the new document is the
definition of the diagnosis itself.
Pediatrician Dr. Roya Samuels, who has reviewed the new
guidelines, agreed. "The definition is more clear-cut, more
precise," she said. But, she added, "There's still no gold standard
for diagnosis. There are different stages of [ear infections], and
making the diagnosis can be tricky."
Because the diagnosis isn't always easy to make, the AAP offers
detailed treatment suggestions, encouraging observation with close
follow-up, but also leaves it up to the discretion of the doctor
whether or not to prescribe antibiotics. If children who are being
observed don't improve within 48 to 72 hours from when symptoms
first began, the guidelines recommend beginning antibiotic
Previous guidelines recommended giving antibiotics for ear
infections in children age 2 and under. The new guidelines suggest
that children aged between 6 months and 23 months can be observed
with close follow-up as long as they don't have severe
Another key component of the new guidelines is pain management.
"Antibiotics take 24 to 48 hours before they start to improve signs
and symptoms, so if a child has fever or pain, it's important to
place them on [pain-relieving or fever-reducing medications],"
The guidelines also confirm that amoxicillin should be the
antibiotic of choice unless the child is allergic to penicillin, or
if the child has been treated with amoxicillin during the past
The new guidance from the AAP also states that children, even
those with recurrent infections, shouldn't be on long-term daily
antibiotics to try to prevent infections from occurring.
Children who have three or more ear infections in a six-month
period, or four or more infections in a one-year period (with at
least one infection occurring in the previous six months), should
be referred to an ear, nose and throat specialist. That's because
children with such frequent infections may need to have tubes
placed in their ears for better fluid drainage.
Finally, the guidelines also recommend staying current on your
child's vaccine schedule, particularly with the pneumococcal
conjugate vaccine (PCV), and the annual flu shot.
"Studies show that anything that decreases viral infection will decrease the incidence of [ear infections]," Lieberthal said.
Both Lieberthal and Samuels said that parents increasingly
understand the importance of trying to reduce the use of
antibiotics. First, because it exposes their child to unnecessary
risks from side effects if they didn't need an antibiotic. And,
second, because parents understand the dangers of developing
"Parents are getting more comfortable with the idea of watching and waiting, as long as they know they can come back for antibiotics if their child's symptoms don't improve," Samuels said.
Learn more about ear infections from the
U.S. National Library of Medicine.
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