The New Ear Infection Rules

Forget what you thought you knew about the best treatment. Your pediatrician may not give you the same old advice anymore.

Otitis Media

Treating kids' ear infections used to be pretty straightforward: Your pediatrician simply handed you a prescription for an antibiotic. Maybe your child is now so familiar with "the pink stuff" that she can practically measure it into the dispenser herself. And you probably know a kid who got multiple ear infections that left his ear so clogged with fluid that it wouldn't drain, so he got ear tubes.

Both treatments are still important weapons in the seemingly endless battle against acute otitis media, the medical term for an infection (almost always bacterial) of the middle ear. Otitis media occurs when the narrow passage connecting the middle ear to the throat swells, and fluid and pressure build behind the eardrum, causing severe pain. But recent research suggests that drugs and surgery are overused. This worries experts, because handing out unnecessary antibiotic prescriptions fuels the rise of antibiotic-resistant germs.

As a result, many medical organizations, including the American Academy of Pediatrics (AAP), now have guidelines that recommend fewer medical interventions for ear infections. First issued in 2004, the guidelines are regularly bolstered by new research, and doctors have gotten on board. "There's been a major shift in thinking," says Allan Lieberthal, MD, a pediatrician with Kaiser-Permanente in Panorama City, California.

Here's the advice you're likely to get from your pediatrician these days -- and why it's best for your child.

"Let's watch and wait."

When you'll hear it: Most of the time.

Ear infections are the most common reason pediatricians prescribe antibiotics, and for some children, drugs are a good choice. But it's not a wise idea to be the parent who demands antibiotics every time your child tugs at his ear. Side effects such as diarrhea, stomach pain, and rashes affect around 7 percent of kids. And doctors worry that many forms of bacteria, including the strain that usually causes ear infections, are becoming resistant to antibiotics, making the drugs less effective against more serious infections. In a University of Texas Medical Branch study that compared watchful waiting with medication, children who received antibiotics were much more likely to carry drug-resistant bacteria by the study's end.

Another reason watchful waiting makes sense: Studies show that about 80 percent of ear infections clear up on their own within a week, since the immune system kills invading bacteria or viruses naturally anyway. In fact, 60 percent of kids feel better in just one day. "Often, a child begins crying and complaining during the night, and by the time I see him in my office the next morning, he's already fine," says Edward O. Cox, MD, director of the division of primary care at DeVos Children's Hospital, in Grand Rapids. "Why prescribe an antibiotic when a child gets better without one?" The AAP agrees and now suggests postponing medications for most ear infections, which spares parents the hassle of forcing kids to swallow syrups, remembering doses, and making sure that all caregivers follow the instructions.

This approach is only appropriate, however, when your child definitely has an ear infection; if it could be a serious illness such as pneumonia or bacterial meningitis, he needs an antibiotic immediately. So the first thing your pediatrician will do is look for telltale ear-infection symptoms: fussiness, crying, fever, and tugging at the ear. If he sees a swollen or stiff eardrum, redness, and fluid when he looks in your child's ear, that usually confirms the diagnosis. If you agree to take a watch-and-wait approach -- treat your child's pain as directed by his pediatrician and track his symptoms -- he should gradually get better over the next 48 to 72 hours. Definitely call the doctor if your child doesn't feel like playing or still has pain or a fever beyond that point.

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