Playing It By Ear: Infections Don't Always Require Antibiotics

Playing It By Ear: Infections Don't Always Require Antibiotics


No parent wants to see their child rub their tiny ears in pain.

So it's understandable that when many parents see their pediatrician about a possible ear infection, they want fast relief for their child.

But new guidelines for the treatment of middle ear infection, also known as acute otitis media, suggest that the best route to recovery might not always be via antibiotics.

Middle ear infection is the most common bacterial illness in children. Concerns about the widespread use of antibiotics leading to antibacterial resistance prompted the development of the middle ear infection guidelines for otherwise healthy children, which were issued on March 9th by the American Academy of Pediatrics and the American Academy of Family Physicians. Antibacterial resistance can cause hard-to-treat infections that can spread throughout communities.

"The approach here is groundbreaking in that this is the first time national organizations are recommending withholding antibiotics for what is mostly a bacterial infection," says guideline coauthor Richard M. Rosenfeld, MD, director of pediatric otolaryngology at Long Island College Hospital in Brooklyn, New York. "We're trying to balance the benefits and harms of antibiotics to help target the antibiotics to the kids who benefit most."

An accurate diagnosis is one of best ways to ensure antibiotics are used appropriately.

According to the guidelines, a diagnosis of middle ear infection requires the abrupt onset of the illness within the last 24 to 48 hours; the presence of middle ear fluid or pus; and signs and symptom of inflammation such as ear pain or a reddened ear drum.

It's particularly important for pediatricians to distinguish between middle ear infections and a condition called middle ear fluid, which can accompany upper respiratory infections, does not cause pain, and does not respond to antibiotics.