Guidelines
for Ear Infection: Antibiotics May Come Second
Concern
about the rising rate of antibiotic use, leading to resistance
of the germs that cause middle ear infections, has prompted
new guidelines encouraging lower use of antibiotics, issued
by the American Academy of Pediatrics
and the American Academy of Family Physicians.
 With
the new guidelines, a physician may suggest waiting
a while for antibiotics or even skipping the medication altogether.
Middle
ear infection, called acute otitis media, is the most common
bacterial illness in children and the one most commonly treated
with antibiotics.
More
than 5 million cases of acute middle ear infections occur
annually in the US, according to the American
Academy of Pediatrics. And more than 10 million antibiotic
prescriptions are written each year to manage those infections.
Experts
Agree to Standards
The
number of prescriptions will probably decline, without an adverse
effect on children's health, in the wake of the new guidelines.
While
the goal is to cut down on unneeded antibiotics, "this is not
a recommendation not to give antibiotics," says Dr. Allan Lieberthal,
a pediatrician at Kaiser Permanente in Panorama City, Calif.,
and lead author of the new guidelines.
Rather,
the goal is to postpone or sometimes eliminate the use of antibiotics.
Parents should also understand the guidelines cover basically
healthy children only.
"The
key part of this is, it is for selected children," Dr. Lieberthal
says.
The
guidelines are primarily intended for children two years
of age or older who are not seriously ill or have some
underlying condition, Dr. Lieberthal notes.
Excluded
from the guidelines are children with chronic illnesses that
affect the ear. This would include, for instance, children born
with a cleft palate, which predisposes them to chronic middle
ear infections.
Also
excluded are children with genetic conditions such as Down syndrome,
immune system disorders, and hearing-impaired children with
cochlear implants, he says.
There
are three key components to the new guidelines, according to
Dr. Lieberthal. "The first is accurate diagnosis. The second
is treatment of pain," he says.
Then,
a physician must decide if antibiotics are needed at all.
"Selected
children with ear infections may not need antibiotics," says
Dr. Lieberthal. "More than 80 percent of the children
who meet the guideline definition [of those who might not need
antibiotics] get better without antibiotics."
Each
course of antibiotic given to a child can make future infections
more difficult to treat. The result is an increase in the use
of a larger range of - and generally more expensive - antibiotics.
In addition, the benefit of antibiotic for acute otitis media
is small on average, and must be balanced against potential
harm of therapy.
Guidelines
include the following:
-
Accurately diagnosing acute
otitis media and differentiating it from otitis media
with effusion (middle ear fluid), which requires different
management.
-
Relieving pain, especially
in the first 24 hours, with ibuprofen or acetaminophen.
-
Giving parents of healthy
children the option of fighting the infection on their
own for 48 to 72 hours, then starting antibiotics if they
do not improve.
-
Encouraging families to prevent
acute otitis media by taking steps to reduce risk factors.
For babies and infants this includes breastfeeding for
at least six months, and eliminating exposure to passive
tobacco smoke.
-
If antibiotic treatment is
agreed upon, the physician should prescribe amoxicillin
for most children.
It
is also crucial, Dr. Lieberthal explains, for parents to
observe the child closely and to keep the physician informed
about their child's condition, so antibiotics can be prescribed
if needed.
Another
expert, Dr. Dennis Woo, chairman of pediatrics at Santa Monica-UCLA
Medical Center in California, says the new guidelines "give
credibility to what a lot of us were already doing."
Antibiotics
should still be prescribed under certain conditions, according
to the guidelines. For instance, children six months old
or younger should receive the medications if they have
a diagnosed or suspected middle ear infection.
For
children age six months to two years, antibiotics should
still be prescribed if the diagnosis is a suspected or certain
middle ear infection with severe symptoms. If the symptoms are
not severe and the diagnosis is suspected or uncertain
middle ear infection, observation is an option.
For
children ages two to 12 years, antibiotic treatment is
recommended for certain middle ear infections with severe symptoms,
and observation is an option for suspected or non-severe middle
ear infection without severe symptoms.
Putting
the guidelines into operation may work best in a practice setting
where the physician knows the families and the parents
understand the importance of keeping the physician posted
on the child's status, Dr. Woo says.
Both
Drs. Woo and Lieberthal agreed there is no danger to postponing
antibiotics in healthy children if they are watched closely.
Always
consult your child's physician for more information. |
Otitis
media is inflammation located in the middle ear. Otitis media
can occur as a result of a cold, sore throat, or respiratory
infection.
About
75 percent of children have at least one episode of otitis media
by the time they are three years of age.
Nearly
half of these children have three or more episodes by the time
they are three years of age.
Otitis
media can also affect adults, although it is primarily a condition
that occurs in children.
Otitis
media is the most common diagnosis for children in the US.
Otitis
media occurs more often in the winter and early spring.
While
any child may develop an ear infection, the following are some
of the factors that may increase a child's risk of developing
ear infections:
-
being around someone who
smokes
-
family history of ear infections
-
a poor immune system
-
spends time in a daycare
setting
-
absence of breastfeeding
-
having a cold
-
bottle fed while laying on
his/her back
Middle
ear infections are usually a result of a malfunction of the
eustachian tube, a canal that links the middle ear with the
throat area.
The
eustachian tube helps to equalize the pressure between the outer
ear and the middle ear. When this tube is not working properly,
it prevents normal drainage of fluid from the middle ear, causing
a buildup of fluid behind the eardrum.
When
this fluid cannot drain, it allows for the growth of bacteria
and viruses in the ear that can lead to acute otitis media.
The
following are reasons that the eustachian tube may not work
properly:
-
a cold or allergy which can
lead to swelling and congestion of the lining of the nose,
throat, and eustachian tube (this swelling prevents the
normal flow of fluids)
-
a malformation of the eustachian
tube
Always
consult your child's physician for a diagnosis.
|
