Ear Infections - Treatment

Treatment

Many of the treatments for ear infections, particularly antibiotic use and surgical procedures, are often unnecessary in many children. Between 80 - 90% of all children with uncomplicated ear infections recover within a week without antibiotics. Likewise, receiving antibiotics for an acute ear infection does not seem to prevent children from having fluid behind the ears after the infection is cleared up. Antibiotics are rarely recommended for otitis media with effusion. In addition, the overuse of antibiotics has led a serious problem of bacterial strains that are resistant to common antibiotics.

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Antibiotics are necessary for treatment of some children with acute otitis media, particularly those who are younger than age 6 months.

Treatment Guidelines for Acute Otis Media (AOM)

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) guidelines and recent evidence support the following recommendations:

• Accurate diagnosis of AOM including differentiation from OME.
• Children younger than 6 months of age should receive immediate antibiotic treatment.
• Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen.
• An initial observation period of 48 - 72 hours ("watchful waiting") is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment. (Most children do improve within 72 hours.)
• For children aged 6 months - 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe. For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis. Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2 °F (39 °C).
• Preventive antibiotics (antibiotic prophylaxis) may be recommended for recurrent acute otitis media. Which children should be treated this way, as well as which antibiotics and for how long, have not been clearly determined.