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New Guidelines for Ear Infection Treatment


It’s about as common in early childhood as PB&J: a runny nose that travels back into the ear canal, resulting in a feverish, cranky, sleepless kid (and parents). But now the usual ear infection cure—that Pepto-Bismol pink liquid antibiotic known as amoxicillin—may not be handed over at the pediatrician’s office quite so quickly, thanks to a new treatment policy issued today by the American Academy of Pediatrics (AAP). Described as “watchful waiting,” the new guidelines for ear infections, known clinically as acute otitis media (AOM), emphasize an approach that has been tested by pediatricians since the last AAP policy update in 2004.

At that time, due to concerns of overprescribing and resulting antibiotic resistance, doctors were encouraged to hold off on the pink drink if kids were over age 2 and did not seem to be suffering terribly. In the resulting years, it’s been determined that as many as 70% of ear infections clear up on their own without antibiotic treatment, explains Allan S. Lieberthal, M.D., chair of the AAP subcommittee on acute otitis media and lead author of the new clinical practice guideline. 

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Hence the doctor’s group now feels comfortable broadening this approach. “The key to proper management of AOM is to make an accurate diagnosis,” notes Dr. Lieberthal. “The most important change from the 2004 guideline is the working definition of AOM.” Previously the three-part definition included 1) acute onset of symptoms; 2) the presence of fluid (effusion) in the middle ear; and 3) inflammation. The new guideline requires that the tympanic membrane must also be visibly bulging.

Worried that your child will suffer needlessly without an antibiotic (hey, ear infections hurt!)? Don’t be. Antibiotics will still be given if ear pain is moderate to severe, lasts for at least 48 hours, or is accompanied by a temperature of 102.2 degrees or higher. Children under age 2 with both ears affected will also be given an antibiotic. 

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If your child’s pediatrician recommends a wait-and-see approach, your opinion will be taken into consideration when making the final decision. If you do hold off on antibiotic treatment, make sure you check back in with the doctor’s office if symptoms fail to improve or worsen in the next 48 to 72 hours.

Read more on treating a child with an ear infection.

Do your doctor encourage you to hold off on antibiotics for ear pain? Leave a comment.