The New Ear Infection Rules

"Your child needs an antibiotic."

When you'll hear it: Only in special circumstances.

Your child's age plays a big role in this situation. Babies under 6 months should get medication because they're at higher risk of contracting serious illnesses, including bacteremia, a blood infection. And most parents of children under 2 will walk away with a prescription because the consequences of antibiotic resistance or a bad reaction to an antibiotic outweigh the risk of a major illness.

Pediatricians will also usually prescribe an antibiotic if a child seems sicker than expected from an ear infection. "You wonder whether something more serious is going on when a child is extremely irritable, is less alert than you'd like, or isn't responding to her parent," says Dr. Cox.

Ear infections often begin after a cold that causes the eustachian tube to swell, trapping fluid inside, where bacteria like to breed. If your child's didn't start that way, it could be a sign of a more serious infection. In this case, a doctor might give her an antibiotic. She may also get one if you tried watchful waiting but she got another ear infection within 30 days -- she may need a continuous low dose of antibiotics to stop the recurrence, or antibiotic eardrops if her infections generate pus.

Because a certain amount of personal judgment goes into deciding whether to use antibiotics, doctors may write a "safety net" prescription that parents will fill if ear pain persists for 48 to 72 hours. "It's a joint decision," says Dr. Lieberthal. "The parent takes the prescription but waits a few days before filling it." You may not need it, since studies suggest that 70 percent of prescriptions aren't filled. When doctors do prescribe, they usually start with amoxicillin, which works more than 80 percent of the time. If it doesn't (possibly because of bacterial resistance), broader-spectrum and more expensive drugs such as Omnicef are often the second line of defense.

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