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Docs Say No To Earache Antibiotics

Parents of cranky children with ear infections be warned: Antibiotics may no longer be what the doctor orders.

Two leading medical groups are expected to recommend this spring that doctors stop treating most ear infections in children with antibiotics, federal health officials said Tuesday.

The move contradicts years of pediatric practice and is expected to disappoint weary parents of whimpering, infected toddlers.

About half of all antibiotics prescribed to preschool children are for treating ear infections. Health officials believe if they can reduce child antibiotic use for such infections, they can stop the rise of antibiotic-resistant germs created by overuse of the drugs.

"It will mark a dramatic change in appropriate antibiotic use," said Dr. Richard Besser, acting chief of the meningitis and special pathogens branch of the Centers for Disease Control and Prevention.

The guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians must be formally approved by the medical bodies before they are published for doctors.

For years, health officials have been battling improper antibiotic use by emphasizing that the drugs should not be used for viruses, such as colds, because they do no good.

This time, health officials are going even further, urging that antibiotics also be withheld for bacterial ear infections if they appear to be minor.

Most children with ear infections - about 80 percent - typically recover in two to seven days, Besser and other experts say.

"We are making a societal trade-off -- at the individual level, some kids may have a little bit longer course of their infection, but for society as a whole, we will be better served if we don't give them," said Dr. Richard Rosenfeld, a member of the committee reviewing the guidelines.

"We should save the power of antibiotics for people with real significant illnesses where 80 percent don't get better in a day or two and can actually die," he said.

As the guidelines are currently proposed, doctors would prescribe antibiotics only for children with serious middle ear infections, known as acute otitis media. Symptoms include a minimum fever of 102.6 degrees or severe ear pain. Milder cases would simply be observed.

Between 5 million and 6 million children under age 5 suffer ear infections each year. Antibiotics are prescribed in many of those visits, said Rosenfeld, also director of pediatric otolaryngology at Long Island College Hospital in Brooklyn, N.Y.

About 10 million prescriptions each year are written for ear infections in children of all ages.

Health officials believe the new guidelines won't cause any extra office visits for parents, although they may be asked to update pediatricians with their child's condition by phone, said Dr. Allan Lieberthal, co-chairman of the medical groups' committee reviewing the guidelines change.

A specific definition for doctors of what constitutes a serious ear infection also is expected to reduce antibiotic overuse.

"Antibiotics only will be considered if it's truly acute otitis media and not every abnormal-appearing ear," Lieberthal said.

Medical studies have found the antibiotics do very little for a child's ear infection pain. Common painkillers such as acetaminophen or ibuprofren are effective for that, said
Lieberthal, also a pediatrician for Kaiser Permanente in Panorama City, Calif.

"Since the discovery of penicillin, when there is a bacterial infection, antibiotics are given," Lieberthal said. "Because of the increasing resistance of common bacteria to antibiotics, the importance of limiting their use is essential."

By Daniel Yee

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