New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.
But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:
- Proper inspection
- Pain control (Tylenol or Advil, etc). Ear infections hurt!
- Observation (waiting for 48-72 hours for relief)
- Treatment with high-dose Amoxicillin first and foremost if selected to treat.
- Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
- Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)
But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read More »