American Academy of Pediatrics and the American Academy of Family Physicians guidelines help doctors and parents decide on the best treatment for ear infections in children.

Most Ear Infections in Children Get Better without Antibiotics

*In the news*   Using antibiotics when they are not necessary promotes the development of bacteria that are resistant to antibiotics. For this reason, doctors have been trying to identify certain types of infections that do not need to be treated with antibiotics, and fewer antibiotics are being used. Many infections – such as the common cold, acute bronchitis, or sinus congestion that has been present for less than a week – are caused by viruses. Antibiotics are not able to improve viral infections.

Some ear infections (acute otitis media) in children are different. Although many are caused by viruses, a substantial number are indeed caused by bacteria. In fact, acute otitis media is the most common infection for which antibiotics are prescribed for children in the United States. However, most ear infections, even those caused by bacteria, will get better in a few days without antibiotics.   The latest American Academy of Pediatrics and the American Academy of Family Physicians guidelines help doctors and parents decide on the best treatment for ear infections in children.

These guidelines do not say that doctors should never use antibiotics for ear infections. Instead, they urge doctors to first make a careful diagnosis (not immediately labeling all ear pain as acute otitis media), to focus on pain relief, and to consider not using antibiotics immediately, especially in children who are over age 2 years with mild or moderate ear findings. Even children ages 6 months to 23 months with a mild infection in only one ear usually don’t need immediate antibiotic treatment.    Doctors and parents alike often think an antibiotic should be prescribed when the diagnosis of ear infection is made. Therefore, changing the norm by using these new guidelines may feel somewhat uncomfortable. A strong case can be made, though, for the good of the child as well as for the public.

  • Antibiotics could cause your child more harm than good. While treating an infection, they also kill harmless bacteria (called “normal flora”) that are normally found in the mouth and throat, intestine, skin, and vagina. When these natural bacteria are eliminated, other potentially harmful bacteria strains that are resistant to the antibiotic can make use of the abandoned resources and can multiply more easily. For example, when antibiotics kill the normal flora in the intestine, the bacteria Clostridium difficile can grow, causing severe diarrhea. Growth of non-bacteria agents such as yeast can result in irritation and yeast plaques on the throat or in the vagina.
  • Bacteria that are resistant to an antibiotic prescribed for your child will survive treatment, and they can multiply and colonize your child’s nose and airway. The next infection your child has may be more severe, yet it may not respond to usual treatment.
  • For the benefit of the community at large, it is most important that we slow the emergence of drug-resistant bacteria. Expansion of any population of drug-resistant bacteria can affect the safety of the whole human race, since we are left holding ineffective drug-weapons to fight them when these bugs do cause a serious infection.

Doctors who are prescribing antibiotics more sparingly are practicing good medicine, and this includes avoiding antibiotics for many childhood ear infections, when appropriate. However, ear infections in children younger than 6 months and those in older children with more severe symptoms will continue to be treated with antibiotics.  It is still important to speak with your child’s doctor if your child has symptoms of an ear infection. The guidelines emphasize the importance of a careful exam and a good history to make an accurate diagnosis of ear infection. You can help your doctor decide whether your child’s ear infection is severe enough to need antibiotics by accurately reporting symptoms. Take your child’s temperature and record the level of fever. If your doctor has specified a safe dose of acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) for your child, try treating symptoms before your doctor examines your child, so that the effectiveness of pain medicines can be evaluated.

If you and your child’s doctor decide not to give antibiotics right away, the doctor will want to know if he or she is not improving as expected. This includes having more pain or fevers, or no improvement in the presenting symptoms after 48 to 72 hours. Antibiotics may then be necessary.    The guidelines also emphasize prevention of ear infections. Keep up to date on your child’s immunization schedule. Maintain a non-smoking home and do not let others smoke around your child. Do not give your baby a bottle while she is lying down.

Try to stop (or at least limit) using a pacifier after 6 months of age. Breastfeeding an infant also appears to lower a child’s risk of ear infections.