Doctors Advised to Wait and See on Ear Infections

Middle ear infections are the main childhood problem that leads doctors to prescribe antibiotics. But until now, there has been little to guide doctors in treating what they call acute otitis media with effusion, or fluid in the middle ear.

"What we now know is 90 percent of these infections will get better without using antibiotics, if we just watch the child and let the illness run its natural course," says Richard M. Rosenfeld, M.D., M.P.H. Dr. Rosenfeld co-chairs the American Academy of Pediatrics (AAP) subcommittee on otitis media with effusion. Since just 10 percent of kids will need antibiotics, "we're exposing a large number of children to the side effects" for no cause.

The AAP and American Academy of Family Physicians (AAFP) set up a panel to study ear infections in kids 2 months old to 12 years old. In May 2004, this panel released guidelines for the treatment of acute otitis media in otherwise healthy children, ages 2 to 12, without underlying conditions that may alter the natural course of acute otitis media. Here's what those doctors had to say:

• The doctor should decide to use antibiotics with input from the parents. But both should think about watching the child for a few days first, says Ted Ganiats, M.D., cochairman of the AAP/AAFP panel. That holds true as long as the child does not have a very high fever or other severe problem.

• The doctor should ask about pain and prescribe acetaminophen or ibuprofen when needed. Treating the child's pain is the key step the doctor can take, Dr. Ganiats says.

• The doctor should be frank with parents about the certainty of the diagnosis. That may help parents weigh their treatment options.

• If the child fails to improve after two or three days without antibiotics, it's time to use them. If antibiotics end up being prescribed, parents should be sure to give the child the correct dose at the prescribed times of day.

• Parents should be taught about prevention. Bottle-feeding, pacifiers, and cigarette smoke can raise the odds of these infections. Getting the appropriate childhood immunizations, particularly the pneumococcal and Hib vaccines, can help prevent otitis media.

• Doctors should tell parents that they don't know enough yet about alternative medicine and ear infections to back such treatments.