Q. My 2-year-old gets frequent ear infections, but my doctor told me he doesn't need antibiotics. What's the story?
A. Until recently, experts believed that all children with otitis media (the medical term for ear infections) needed antibiotics to get better. It's only over the past few years that some doctors have started to take a "wait-and-see" approach before prescribing them; in fact, the American Academy of Pediatrics is revising its official treatment guidelines to advise this as well. The reason: When antibiotics are given too often, bacteria become resistant to them, so they should be reserved for whenever they're really needed. And the older the child -- especially if he's over 2 -- the more likely an ear infection will resolve without antibiotics.
Postponing treatment for a few days helps pediatricians determine whether the problem is really an ear infection. When a child has a cold or allergies, fluid often collects in the middle ear. This effusion will either remain harmless and drain on its own or act as a culture medium for germs and become infected. If no other signs of an ear infection develop -- such as fever, pain, redness, and swelling of the eardrum -- your child likely won't need antibiotics.
These are just guidelines -- each doctor will still have to make a patient-by-patient call. What helps me decide whether to prescribe antibiotics is to determine if the fluid in the ear is accompanied by signs of a sinus infection -- draining or swollen eyes, a lingering cold, and general tiredness. (In these cases, I do.) Past medical history is also important. If waiting a few days has worked before, for instance, I'm more conservative about prescribing antibiotics. But if a child typically gets a full-blown infection anytime he has fluid in his ear, I'll usually give them at the beginning of the illness.
The bottom line: If your child is diagnosed with an ear infection, talk to your doctor about the best course of action. And even if she recommends that you hold off treatment for a few days, call her if your child gets progressively sicker. In that situation, she'll likely decide that antibiotics make sense.