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Less Is More For Ear Infections

Almost 10 million prescriptions for antibiotics are written for ear infections in children each year, a number that many health experts believe is contributing to the problem of drug-resistant bacteria. Now, there are new guidelines for prescribing antibiotics for ear infections.

Dr. Richard Rosenfeld of the Long Island College Hospital in New York is at the forefront of efforts to implement those guidelines. Thursday on The Early Show, he discussed the strategy that contradicts years of pediatric practice of treating ear infections in children.

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

Antibiotics only will be considered when a child has true acute otitis media — not in every case. While the child is under observation, common painkillers such as acetaminophen or ibuprofren are suggested for pain. With appropriate follow-up care, the observation option does not increase the number of complications and the outcome is about the same as treatment with antibiotics in the first place.

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Rosenfeld says that about 80 percent of children with ear infections typically recover in two to seven days. He calls reducing the prescriptions for these cases a "societal trade-off." At the individual level, some kids may have a longer course of infection, but society, as a whole, will be better served if we don't give them. The power of antibiotics should be saved for people with significant illnesses in which the majority don't get better quickly, and can actually die.

Dr. Rosenfeld urges parents to look at ear infections as an "occupational hazard of childhood" and to help their children outgrow this hazard without demanding antibiotics every time they occur. He points out that antibiotics does nothing to relieve the pain and in fact help contribute to the far more menacing problem of antibiotic-resistant bacteria.

Here are the proposed guidelines:

For certain diagnosis


  • Age Under 6 Months: Antibiotics
  • Age 6 Months to 2 Years: Antibiotics
  • Age 2 years and older: Antibiotics for severe illness; observe for non-severe illness

For uncertain diagnosis

  • Age Under 6 Months: Antibiotics
  • Age 6 Months to 2 Years: : Antibiotics for severe illness; observe for non-severe illness
  • Age 2 years and older: Observe
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