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Doctors are being advised to withhold antibiotics for two to three days for many children with earaches in an effort to curb the growing problem of antibiotic resistance.
The "watchful waiting" campaign will be rolled out nationwide by the American Academy of Pediatrics this fall. It began in New York in October.
About 10 million prescriptions for antibiotics are written every year for kids with ear infections, accounting for nearly half of all antibiotic use among preschoolers.
But 81 percent of the ear problems go away without medication, according to the U.S. Agency for Healthcare Research and Quality, a division of the Department of Health and Human Services.
And bacteria are increasingly outpowering the antibiotics, leading to resistant strains that can't be controlled.
"You're not getting a lot of bang for your antibiotic buck with this disease," Dr. Richard Rosenfeld, a pediatric ear, nose and throat specialist at Long Island College Hospital in Brooklyn, said Thursday. He spoke at a Centers for Disease Control and Prevention conference in Atlanta and is helping the Academy of Pediatrics finalize its guidelines.
The new guidelines tell pediatricians and family physicians to hold off on antibiotics for children older than 6 months if doctors aren't sure of a true ear infection.
All children under 6 months with earaches should get antibiotics right away, along with children under 2 years when a diagnosis of infection is certain.
Children older than 2 who have a definite infection and those between 6 months and 2 years with an unclear diagnosis should get antibiotics immediately if they have a fever higher than 102 degrees or extreme ear pain, doctors were advised.
Antibiotics should be given for just five days --- instead of seven to 10 days --- for children older than 2, under the new guidelines.
In applying the new technique, doctors may write prescriptions for antibiotics and tell parents to wait two to three days before filling them, if needed. Or they may ask parents to call in for orders over the phone, or return for follow-up visits.
Physicians should recommend pain medications such as Tylenol or ibuprofen for earaches, Rosenfeld suggested, because the drugs are better at controlling pain than antibiotics.
Many earaches are viral and don't involve fluid in the middle ear, a sign of infection. Nearly 20 percent of true ear infections are caused by viruses for which antibiotics don't work.
Bacterial ear infections come on quickly and are accompanied by fluid and pain. Doctors use scopes that emit puffs of air to detect fluid. Sometimes they use instruments that measure sound waves or the flexibility of the eardrum.
Tissue samples are taken for testing only in extreme or persistent cases, as the process involves putting a needle through the eardrum.
Bacterial ear infections can be serious if untreated, possibly leading to hearing loss or meningitis, a sometimes fatal swelling of the brain. Experts say those complications are rare.
It may take a while for parents to accept the new approach away from routinely using antibiotics to treat their children, said Dr. Gerald Reisman, with Dunwoody Pediatrics in Atlanta.
"Parents often have the expectation that their child is sick and needs an antibiotic to get well, and some really put the pressure on," he said. "But now we can say, 'It's not just me. It's the CDC and the Academy of Pediatrics.' "
Dr. Rich Bessler, a CDC infectious disease specialist, said a few countries in Europe have successfully implemented campaigns to delay antibiotic use for earaches.
Rosenfeld said parents need to realize that an earache, even though sometimes painful, is almost always harmless.
"It's an occupational hazard of being a kid," he said.
Copyright 2003 The Atlanta Journal-Constitution