Medical Info: New Guidelines for Treating Ear Infections

Many of you may have heard that there are "new recommendations" for treating ear infections in children. This is both true and not true. Middle ear infections (different from "swimmer's ear" which is an outer ear infection) is a very common reason for children to be seen by their pediatrician, and the treatment of these infections is, like virtually all areas of medicine, frequently changing. Reasons for changes include more knowledge obtained from studies, newer antibiotics, sociologic changes such as increased day care, etc. It is true that some new guidelines have been published recently that look at middle ear infections in light of all these changes. The number one factor that has led to guidelines changing over recent years continues to be the growing problem of antibiotic resistance. The general idea here is that the more antibiotics are used, the less effective they become against certain bacteria. Therefore, we all have an obligation to try to use antibiotics only in situations where they are truly necessary. That, in a nutshell, is what has led to some new suggestions for treating ear infections.

The area of the new guidelines that has received the most publicity is the growing idea that not all children with ear infections need antibiotics. Many parents have come into the office and said, "I heard that they are not recommending treating ear infections with antibiotics anymore." While this is the way the information is sometimes conveyed in the media, this is only partially true. Taking a closer look at the published guidelines helps us see the information in a clearer light.

First, these particular guidelines are only for "non-complicated, non-recurrent, non-persistent" cases of middle ear infection. What this means is that for many of you who have had ongoing or numerous, repeated battles with ear infections in your child, these guidelines do not apply to you.

The second important aspect of the guidelines is that observation (i.e. not giving antibiotics) is only an option for selected children. Who are these "chosen ones"? Children who are felt to not have severe ear infections and children over the age of two years old. Children 6 months - 2 years may also be observed if the doctor is unable to tell for sure if the ears are infected. These children would likely need to be re-evaluated the following day to see if at that point the diagnosis is able to be made more definitively. In those select children for whom observation is an option (and the doctor and the parents choose that option), attempts are made to control the pain with medications, and if the child has not improved in 2-3 days, then antibiotics would be started.

Because of the increasing concern of antibiotic resistance (and because not wanting to give your child medicine if they do not need it), making an accurate diagnosis that your child truly has an ear infection is very important. That is why we as pediatricians make such a big deal about being able to get a good look at your child's ears (often needing to restrain them, clean their ears, etc.). We realize this is sometimes unpleasant for the child and thus makes a lot of enemies for us among the 2 year olds of Central Florida, but it is simply because we want to make sure we are treating your child correctly.

Another aspect of the guidelines is simply a continued emphasis on trying to prevent ear infections. A few of the most proven ways to do this is to encourage breastfeeding (especially for the first six months of life) and to alter day-care situations. If day-care is unavoidable (as it is for many families), then trying to find a situation with fewer than six children may help cut down the number of ear infections your child develops. One other measure to prevent ear infections is receiving a yearly flu shot.

In reality, these "new guidelines" are not very different than what we have already been doing. As some of you may have encountered, we have been giving the option of withholding antibiotics in older children with mild ear infections. So, while the guidelines are not the sweeping changes you may have been led to believe, they are a continued effort to adapt and do what is in the best interests of all children.