Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Doctors Revise Ear Infection Treatment Guidelines Urge Fewer Antibiotics

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Doctors Revise Ear Infection Treatment Guidelines Urge Fewer Antibiotics

Article excerpt

The sudden onset of symptoms -- pain or fever or just grumpiness during a cold -- is more than enough to send parents and their children running straight to the doctor.

But too often, the result of those visits is a diagnosis of an ear infection and a prescription for an antibiotic, according to the American Academy of Pediatrics.

The AAP is releasing new guidelines that aim to reduce the number of diagnoses of ear infections. The guidelines, being published today in Pediatrics, have not been updated since 2004.

The new guidelines put more emphasis on distinguishing between an acute ear infection and just inflammation of the middle ear -- the difference being that antibiotics are effective against ear infections, but not inflammation.

Correctly diagnosing an ear infection isn't as easy as parents might think, said Farrel Buchinsky, director of pediatric otolaryngology at Allegheny General Hospital.

"Parents think that to make the call of an ear infection is just to stick the otoscope in the ear, as if there's someone standing there with a sign saying 'Ear Infection' or 'No Ear Infection' and you're done," he said. "The diagnosis of [an ear infection] is not half as straightforward as parents would believe."

It can be difficult to get a good look inside the ear of a squirming, crying child, he said, and the view of the eardrum might be blocked by earwax.

Whereas the previous diagnostic criteria focused on acute onset of symptoms, fluid in the ear and inflammation, the new guidelines recommend that doctors see at least some bulging of the eardrum or discharge from the ear. With just mild bulging of the eardrum, doctors also need to see either a sudden onset of pain or intense redness of the eardrum. Doctors also should only diagnose an ear infection if they see fluid in the middle ear.

Research, especially since 2004, clearly shows us that bulging of the eardrum "is the key to bacterial infections in the middle ear," said Allan Lieberthal, a professor of pediatrics at the University of Southern California and a co-author of the new guidelines. …

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