In the first update to its treatment recommendations for acute otitis media since 2004, the American Academy of Pediatrics is recommending that providers take a wait-and-see approach in certain cases instead of immediately prescribing an antibiotic.
 
The intent is to cut down on over use of the drugs, which many experts believe is contributing to the spread of antibiotic-resistant infections.
 
For example, children aged 6 months to 2 years old who have an infection in one ear but don’t have a high fever, severe pain or other complications can be watched for 48 hours without antibiotic treatment to see if the infection gets worse, according to a report in the Huffington Post.
 
If the child worsens or fails to improve within 48 to 72 hours of onset of symptoms, AAP says “a mechanism must be in place to ensure follow-up and begin antibiotic therapy.”
 
The guidelines do recommend that providers assess the level of pain and recommend treatment to reduce it.
 
Here’s an example from the new guidelines of when you would immediately prescribe antibiotics in children aged 6 months or older: When the patient is exhibiting severe signs or symptoms, including moderate or severe otalgia (ear pain) or otalgia for at least 48 hours, a temperature of 102.2 degrees F (39 degrees centigrade).
 
The AAP guidelines also recommend against prophylactic use of antibiotics to prevent future infections in children who are susceptible.