updated 3/10/2004 12:26:41 PM ET 2004-03-10T17:26:41

Two influential doctors groups published guidelines Tuesday seeking to limit use of antibiotics for ear infections in children.

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The guidelines stress that about 80 percent of children with ear infections get better without antibiotics, and that pain relief should be the top priority.

“We want parents and doctors to first make the child comfortable with pain relievers such as ibuprofen and acetaminophen,” said Dr. Ted Ganiats, co-chair of the joint panel that wrote the guidelines.

“Antibiotics do not relieve pain during the first 24 hours and do not reduce fever any quicker or better than pain medicine,” he said.

Avoiding overuse of antibiotics
The guidelines encourage doctors to initially try pain relief and observation in otherwise healthy children with relatively mild ear infections if they can be assured of adequate follow-up. In such cases, antibiotics could be started if symptoms don’t improve in two or three days, the guidelines say.

If a decision is made to use antibiotics, amoxicillin should be prescribed for most children, say the guidelines, a joint effort of the American Academy of Pediatrics and the American Academy of Family Physicians.

Initial treatment with antibiotics may be appropriate for children younger than 2 and those who are very sick or have a high fever with their ear infections, the guidelines say.

The guidelines pertain to a specific type of ear infection known medically as acute otitis media. It’s the most common infection for which antibiotics are prescribed for U.S. children.

There were an estimated 16 million office visits and more than 13 million antibiotic prescriptions written for ear infections in 2000, the guidelines say.

The groups note that while use of antibiotics for childhood ear infections has long been routine in the United States, in some European countries common practice is observation and pain relief first — which may help stop the rise in antibiotic-resistant germs created by overuse of the drugs.

“If a child is given an antibiotic and doesn’t need it, he or she may build up an antibiotic resistance and not respond to them when needed for a more serious infection, such as pneumonia or meningitis,” said Dr. Allan Lieberthal, co-chair of the guidelines panel.

Word of the new guidelines first came last week at an infectious disease conference in Atlanta. The 24-page guidelines were published on the two groups’ Web sites on Tuesday.

The pediatrics group is based in suburban Chicago and the family physicians group is headquartered in Leawood, Kan.

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