When children are running a fever and are inconsolable most of the night, parents typically think they have an ear infection. And they expect their doctor to prescribe an antibiotic.

That's changing. Under new guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians, pediatricians are more apt to recommend treating the pain before using amoxicillin, a commonly prescribed antibiotic. In fact, doctors may not prescribe an antibiotic at all.

Thwarting Superbugs

This action is in response to the growing public health threat of antibiotic resistance. Repeated and inappropriate antibiotic use creates "superbugs," bacteria that have become stronger than even the strongest antibiotics. In recent years, medical professionals have been urged to limit the use of these drugs.

Parental Response

Many parents seem to appreciate the new approach, according to Dr. Kathi J. Kemper, a professor of pediatrics at Wake Forest University School of Medicine. "I find that a lot of parents aren't in a hurry to give antibiotics and are reassured by knowing that 80% of ear infections are cured by the child alone without any meds," says Kemper, author of the book The Holistic Pediatrician: A Pediatrician's Comprehensive Guide to Safe and Effective Therapies for the 25 Most Common Ailments of Infants, Children, and Adolescents.

New Treatment Approach

To treat middle ear infection, the AAP and the American Academy of Family Physicians guidelines emphasize pain relief over antibiotics. Parents are given the option, in many cases, to let their kids fight the infection on their own for 48 to 72 hours, and to start antibiotics after that time if there is no improvement.

"The whole purpose of these guidelines was to give people a way to intelligently and safely use this option of observing an ear infection," says Dr. Richard M. Rosenfeld, professor and director of pediatric otolaryngology at Long Island College Hospital in New York City. Rosenfeld served as a consultant to the AAP subcommittee that developed the guidelines.

Some health professionals avoid using antibiotics at all, while others favor more liberal use of the drugs. Each position has its downside, explains Rosenfeld. Untreated bacterial ear infections can lead to serious complications, including mastoiditis—when infection spreads to the mastoid bone of the skull and meningitis—an infection of the brain. On the other hand, treating every ear infection with antibiotics is unnecessary, and every course can make it more difficult to treat future infections in a given child, he says.

Watchful Approach

Rosenfeld sees room for a middle ground. Under the guidelines, for example, antibiotics are recommended for any child under 2 years or who has severe symptoms, he says. These are the kids who benefit the most, he adds.

But for a child who is age 2 or older who has mild symptoms or whose diagnosis is unconfirmed, it's best to watch and wait. The physician may write a prescription for an antibiotic with the stipulation that the parent should observe the child's progress before having it filled.

Easing Pain

Parents needn't worry that they are causing their child undo misery. Studies show that antibiotics do not make the kids feel better in the first 24 hours, assures Rosenfeld.

For pain relief, give children ibuprofen or acetaminophen, especially in the first 24 hours, the guidelines recommend. Kemper prefers ibuprofen for kids who do not have any problems using it. Ibuprofen lasts longer-approximately eight hours-so fewer doses are needed each day.

Your pediatrician may prescribe anesthetic eardrops to reduce pain in the ear. Other alternatives include using a hot water bottle swaddled in a towel or an ice bag wrapped in a washcloth, she advises.

Repeat Infections

For children requiring repeated courses of antibiotics or antibiotic injections to treat ear infections, doctors may suggest inserting ear tubes. These drain liquid from the middle ear, says Rosenfeld, who discusses the regimen in his new book, A Parent's Guide to Ear Tubes.

Bottom Line

When it comes to ear infections, Rosenfeld says, "you don't have to panic, but certainly, persistent symptoms need attention and clarification by the doctor."

About Ear Infections

Middle ear infection, known as acute otitis IVI media, is the most common bacterial illness in children and the one most commonly treated with antibiotics, according to the AAP. More than 5 million cases occur annually among kids in the United States, resulting in more than 10 million annual antibiotic prescriptions and about 30 million annual visits to doctors' offices.

This type of infection starts when germs spread to the middle ear, resulting in a buildup of pus or fluid that can cause painful pressure on the eardrum in some children. The infection can be either bacterial or viral, according to the American Medical Association.

Parents should not confuse ear infections with uninfected fluid in the middle ear. This chronic condition often is only discovered in a physical exam because it does not cause discomfort. It has a different set of management guidelines.

Cough Control

Over-the-counter (OTC) cough medicines are no more effective than sugar water.

The two main ingredients are the cough suppressant dextromethorphan, which can cause insomnia and has sometimes been abused by adolescents...and diphenhydramine, an antihistamine that may cause drowsiness.

Best ways to ease a cough: Saline nose drops...tea...good hydration...humidified air. Also, honey may help and won't hurt.

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