The suggested treatment for acute otitis media, an ear infection, in children has changed. The new practice guidelines appear in a piece titled "The Diagnosis and Management of Acute Otitis Media." The article was released on-line today, and will appear in the March 2013 edition of the journal Pediatrics. The new, evidence based guidelines were developed by the American Academy of Pediatrics and American Academy of Family Physicians.
The National Institute on Deafness and Other Communication Disorders describes ear infections as the second most common infection in children. By the age of three, about 75 percent of all children will have suffered at least one such infection. Parents will often notice their child tugging at an ear, running a fever, crying, being fussy and fluid may drain from the ear.
The Centers for Disease Control (CDC) state that acute otitis media can be caused by either a bacterial or a viral infection. Bacterial infections can be treated with antibiotics, but the new guidelines suggest that physicians observe mild cases rather than prescribe medication. Physicians are urged to conduct a visual examination of the ear as part of their diagnostic routine, and to use pneumatic otoscopy or tympanometry to confirm fluid in the middle ear.
The guidelines make clear distinctions between children with preexisting conditions such as "cleft palate or Down syndrome, immune deficiencies, or cochlear implants" that make them susceptible to ear infections and children without those conditions. "Watchful waiting" is not suggested for every child, and the authors state that followup should ensure that the "watched" child receives antibiotics if the illness worsens or fails to improve in the first 48 to 72 hours.
The new guidelines are intended to reduce the use of antibiotics in children who may not need them, and the side effects of antibiotic use such as diarrhea. They also increase the standard for diagnosing acute otitis media to include measured and observed signs of fluid in the middle ear. The authors also believe that the guidelines will reduce the overdiagnosis of the illness by physicians who may not visualize the eardrum properly.