Ear Infections - Treatment

Treatment

Treatments for ear infections cost the U.S. between 3 and 4 billion dollars each year, and many of these treatments, particularly heavy antibiotic use and surgical procedures, are often unnecessary in many children.

Experts continue to argue about the best approach for treating ear infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME).

Watchful Waiting for AOM. Two studies published in 2005 evaluated the use and effectiveness of watchful waiting. In one study, 223 children with non-severe AOM were randomly prescribed either watchful waiting or immediate antibiotic treatment. The antibiotic group recovered more quickly, but had a high number of side effects and antibiotic-resistant bacterial strains. Parents were equally satisfied with either treatment approach, and two-thirds of children in the watchful waiting group recovered without needing antibiotics. A second study surveyed 2054 parents and 160 doctors on their use and perceptions of watchful waiting. Results indicated that although medical guidelines recommend watchful waiting, few doctors regularly practice it. Parents who had a higher educational level, more knowledge about antibiotics, and greater involvement in medical decisions were more likely to be satisfied with a watchful waiting recommendation.

Treatment Guidelines for Acute Otis Media (AOM) 

In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) released updated guidelines for the management and diagnosis of acute otitis media.

These guidelines include the following recommendations:

• Accurate diagnosis of AOM including differentiation from OME.
• Children less 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 to 72 hours 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 to 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 degrees (39 degrees Celsius).
• If antibiotics are needed, amoxicillin is recommended as first-line treatment (except in children who are allergic to penicillins).