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Moms, the next time your kid has an ear infection, you might want to pass on a prescription. That’s because after analyzing 135 observational and randomized, controlled studies published from January 1999 to July 2010, researchers concluded that antibiotics aren’t always needed to treat the condition. The review, published in the Journal of the American Medical Association, found that antibiotics “are modestly more effective than no treatment” but also cause adverse effects (like diarrhea and rashes) in up to 10 percent of kids.
Surprised? Your pediatrician may not be. “This isn't really a news flash for most clinicians,” says Ari Brown MD, FAAP, a pediatrician and the author of Expecting 411, Baby 411 and Toddler 411. “We know that a good number ear infections will clear on their own without treatment, particularly in older kids.”
Even so, ear infections are the main reason kids in this country get antibiotics, and even in individual practices, many pediatricians have differing opinions about whether to prescribe them. For children who are over 2 years of age, Dr. Brown takes a ‘wait and see’ approach; giving a parent a prescription for an antibiotic like Amoxicillin with instructions to fill it only if the child is not improving. (If the older child is running a fever of 102 or higher and has other signs of a systemic infection, she treats him at the time of diagnosis.)
But for kids younger than 2, her M.O. is different -- especially if they’re running a fever. “I tend to treat ear infections when the diagnosis is clear cut,” she says. The reason? Little kids aren’t verbal enough to tell mommy or daddy if they’re feeling better or not, and they have a higher risk of complications like mastoiditis, where the bacterial infection invades the skull bone. “I don't feel comfortable waiting around to see if they improve without antibiotics,” Dr. Brown says. “This [review] won't change my current practice on that.”
So what’s a worried parent to do? Dr. Brown’s advice is this: “Look at the scientific evidence and discuss it with your doctor. If you feel comfortable supportively caring for your child at home and waiting to see if your child improves before filling that prescription, that's usually the best course.”
Do you ask for antibiotics when your child has an ear infection? Chime in below!