"Maybe not. Concerned about an increase in antibiotic resistance, the American Academy of Pediatrics now recommends a watch-and-wait approach, since most ear infections clear up without antibiotics. This way children aren't exposed to antibiotics unnecessarily."
"What if it doesn't get better?"
"If his symptoms don't subside within a couple of days, we may have to treat him."
"What about the pain?"
"Give him acetaminophen or ibuprofen every four to six hours, as needed, to head off the pain. If he's still hurting after two days, call me."
"That's it," I said as I held out a jar of sugar-free suckers and let her pick out the usual non-staining white one for Tyler.
My little patient's fever dropped from 102? to 99? that day. But two days later, although it seemed Tyler was continuing to improve, Julie found some blood on his pillow and fluid dripping out of his ear. She brought him back to see me.
This time I didn't even need the otoscope to give a diagnosis.
"Tyler has a perforated eardrum," I said.
Julie's face turned white, and Tyler responded to her fear by starting to whimper.
"It's not as bad as you think," I assured her. "An ear infection can behave just like a pimple. Sometimes the fluid from the infection builds up within the eardrum and the pressure can make it rupture. By the way, this can happen whether the ear infection is treated with antibiotics or not. The good news is that once this fluid build-up pops, the pain disappears and the eardrum heals over just like new."
"Um, so no antibiotics?"
"If the fluid doesn't stop draining within a few days or if his fever returns, we may have to give him an antibiotic. We won't know for a couple of days."