Doctors may observe some ear infections to see if they clear up before ordering antibiotics.
By LISA GREENE
Published March 9, 2004
NEW PORT RICHEY - Joey Demitro has had only three ear infections in his young life, but they've been doozies.
The normally energetic 2-year-old gets high fevers and turns crabby and lethargic.
"He really gets them when he gets them," said his mother, Kelly Demitro.
But under new guidelines from two of the nation's largest medical groups, there could be a big difference the next time Joey goes to the doctor's with an ear infection:
He might not go home with antibiotics.
In what could mark a major shift in treatment of one of the most common childhood ailments, the American Academy of Pediatrics and the American Academy of Family Physicians plan to release new guidelines today that suggest doctors observe less severe ear infections to see if they clear up before prescribing antibiotics.
They hope that doing so could eliminate a third or more of the 10-million antibiotic prescriptions written each year and make progress toward easing the growing problem of antibiotic-resistant bugs.
But children who truly need the drugs will get them, doctors say, and children who don't get antibiotics still will get painkillers.
"This is not being suggested as a means of torturing young children," said Dr. Richard Rosenfeld, a consultant for the committee of the American Academy of Pediatrics that formulated the guidelines.
"Giving the doctor and the parents another treatment option is the biggest change," said Dr. Ted Ganiats, a member of the same committee for the American Academy of Family Physicians. "Originally in this country, children diagnosed with ear infections were given an antibiotic. Another option is treating the child's symptoms and watching them."
For many children, repeated ear infections are a rite of passage. All the infections in young kids really aren't surprising, Rosenfeld said.
"They're constantly exchanging juicy bits of bioslime from their noses and throats," he said.
And so parents get to learn the antibiotics alphabet: Augmentin to Zithromax.
Doctors often prescribe antibiotics for children's ear pain and cold symptoms even when it's not clear whether the ear is infected or whether the infection comes from bacteria, which are killed by antibiotics, or from a virus, which isn't affected.
"Really, the majority of the cases now are just plain red eardrums," said Dr. Rani Gereige, an associate professor at the University of South Florida and associate director of the residency program at All Children's Hospital. "You see a red eardrum, you know it's infected, but it's hard to tell if it's a bacteria or a virus."
All Children's doctors already have been trying to cut back on prescribing antibiotics for ears, Gereige said. He estimated that about one-quarter of the ear infections they see now don't get antibiotics.
With the new guidelines, Gereige would expect doctors to be more conservative about starting antibiotics.
Under the guidelines, a child 2 or older with infected ears, but without fever or severe pain, could be observed for a few days to see if she improves on her own, Rosenfeld said.
Children under 2 would get antibiotics even if the infection is mild, he said.
But if the pediatrician isn't certain whether the ear is infected - and often it's hard to tell - doctors might choose to wait on antibiotics for children between 6 months and 2. Children under 6 months still would get antibiotics in that case because their immune systems are less developed, Rosenfeld said.
"The whole purpose of this approach is not to suggest we don't treat ear infections, it's to try to identify the children who will benefit most," he said.
But how will parents feel when they're told their children don't need amoxicillin after all? Several Tampa Bay parents said the change may take some adjustment.
"I think they're overprescribed myself, in a lot of ways," said Tampa resident Andrea Cawley. "But when you have a screaming infant, what do you do?"
Cawley's youngest daughter, Alynn, has just gotten over her sixth ear infection in her 10-month lifetime. Her pediatrician tries to be cautious about antibiotics, Cawley said, but thinks they're a better option than ear tubes at Alynn's age.
In fact, given Alynn's age, severe infections and "frequent flyer status," it seems likely she would still receive antibiotics for infections, even under the new guidelines.
But since Joey Demitro of New Port Richey is older and has had fewer infections, he is more likely to be affected.
"Is he going to clear up on his own? Or is he going to be miserable?" are the questions that Kelly Demitro would ask. "I don't want him to be sick and not be treated."
Most of the time, children get better without antibiotics, Ganiats said.
"Our culture is one where we think that infections require an antibiotic," he said. "But overall, 80 percent of kids get better without antibiotics in a couple of days."
That message already has started to sink in for many parents, said St. Petersburg pediatrician Jan Bender.
"Five years ago, if you had asked me (about parents' reactions), I would have said, "Yeah, everybody wants antibiotics when they come in with ear pain,"' he said. "But there's an acute awareness. Parents, when they're educated properly, will respond."
But even education may not make waiting for antibiotics an easy choice.
"If I go to the doctor and they don't give me anything, I'll be concerned," said Orlando resident Yanira Rodriguez, visiting Tampa with her daughter Gabriela, 3.
Starting when Gabriela was 9 months old, she had a string of several ear infections. Her top concern would be making sure Gabriela gets painkillers if she needs them.
"As long as I don't see her suffer," she said. "You see your kids crying, you feel helpless."