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In an effort to rein in antibiotic use, the American Academy of Pediatrics has issued stricter guidelines on diagnosing and treating ear infections in kids.
The updated guidelines, published in the March issue of the journal Pediatrics, also added a recommendation against prophylactic antibiotic use in kids with recurrent ear infections.
Read this story on www.medpagetoday.com.
The 2013 guidelines are specifically for uncomplicated acute otitis media at ages 6 months to 12 years in otherwise healthy children without tympanostomy tubes, anatomic abnormalities such as cleft palate or Down syndrome, immune deficiencies or cochlear implants.
"We've been waiting for these guidelines for some time," said Dr. Andrew Hertz, medical director of the University Hospitals Rainbow Care Network in Cleveland.
"There's been a movement for a number of years for pediatricians to provide less antibiotics for ear infections and simply observe those children with mild findings on physical examination," he explained in an interview.
"Hopefully, now that there is a practice guideline ... that you don't have to prescribe an antibiotic for every ear infection, this will decrease the use of antibiotics and thereby make antibiotics more successful and more useful when they are prescribed."
The pediatrics organization also cited overdiagnosis, "often without adequate visualization of the tympanic membrane," as a problem.
The 2004 guidelines used a three-part definition for acute otitis media: Acute onset of symptoms; acute middle ear inflammation; and middle ear effusion. The 2013 update also requires middle ear effusion for diagnosis, but it now has to be based on tympanometry or pneumatic otoscopy.
Although early acute otitis media can occur without effusion, the guidelines committee acknowledged, "the risk of overdiagnosis supersedes that concern."
They suggested that clinicians should be aware as they use these criteria that recent onset of ear pain and intense erythema of the ear drum can be the only otoscopic finding.
Other diagnostic criteria are: Moderate to severe bulging of the tympanic membrane or new onset of discharge not due to an infected ear canal; and mild bulging of the ear drum and onset of ear pain within 48 hours, which could be indicated by holding, tugging, rubbing of the ear for nonverbal children, or intense redness of the tympanic membrane.
Antibiotics should be given for severe cases of bilateral or unilateral acute otitis media for children 6 months or older based on ear pain that is moderate or severe, lasts for at least 48 hours, or is accompanied by a temperature of 102.2 degrees or higher.
For less severe cases, watchful waiting could be offered instead of antibiotics in joint decision-making with parents or caregivers. However, kids ages 6 to 23 months with both ears affected should be given antibiotics.
"When observation is used, a mechanism must be in place to ensure follow-up and begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of onset of symptoms," the guidelines noted.
Another change in the 2004 guidelines addressed recurrent acute otitis media, defined as three episodes in 6 months or four in the prior year with one in the past 6 months.
Prophylactic antibiotics shouldn't be prescribed to reduce recurrences, according to the AAP. However, these children may be offered the option of tympanostomy tubes.
These practice patterns should decrease use of antibiotics with the benefit of fewer adverse effects, such as diarrhea and allergic reactions, and decreased potential for bacterial resistance, the guidelines noted.
When antibiotics are given, amoxicillin remains the first-line agent, with drugs with additional beta-lactamase coverage selected for kids who have already had it in the prior month or are allergic to penicillin.
Physicians should recommend the pneumococcal conjugate vaccine and annual flu shot for all children, which can help reduce acute otitis media associated with those infections, the guidelines noted.
Source: http://abcnews.go.com/Health/watchful-waiting-best-ear-infections-pediatricians/story?id=18589352
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By Kurt Schlosser, TODAY
Academy Award winners who went on a little too long in their acceptance speeches Sunday night received an ominous warning from the orchestra at the Dolby Theater ? the theme music from "Jaws" started playing.
Da nuh. Da nuh. Da nuh ...
Anyone familiar with movies should recognize the music, by composer John Williams, used to signal a coming shark attack in?Steven Spielberg's 1975 classic about a very hungry great white. The?haunting bass tones struck us as a?little jarring compared to the gentle string orchestras usually used to urge people to leave the?stage.
Da nuh. Da nuh. Da nuh ...
The music was used Sunday when "Life of Pi"?won the Oscar for best visual effects and again when "Searching for Sugar Man" won for best documentary feature. Actress Nicole Kidman?was even caught on camera mouthing "poor thing" to her husband Keith Urban as the music got louder to drown out winning "Sugar Man" director Malik Bendjelloul as he rambled on.
Da nuh. Da nuh. Da nuh ...
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BARCELONA, Spain (AP) ? Samsung Electronics is beefing up its tablet range with a competitor to Apple's iPad Mini that sports a pen for writing on the screen.
The Korean company announced on Sunday in B'arcelona that the Galaxy Note 8.0 will have an 8-inch screen, putting it very close in size to the Apple's tablet, which launched in November with a 7.9-inch screen. It's not the first time Samsung has made a tablet that's in the Mini's size range: it's very first iPad competitor had a 7-inch screen, and it still makes a tablet of that size, but without a pen.
Samsung will start selling the new tablet in the April to June period, at an as yet undetermined price. It made the announcement ahead of Mobile World Congress, the wireless industry's annual trade show, which starts Monday in Barcelona, Spain.
The Note 8.0 fills a gap in Samsung's line-up of pen-equipped devices between the Galaxy Note II smartphone, with its 5.5-inch screen, and the Galaxy Note 10.1, a full-size tablet. Samsung has made the pen, or more properly the stylus, one of the tools it uses to chip away at Apple's dominance in both tablets and high-end smartphones. Apple doesn't make any devices that work with styluses, preferring to optimize its interfaces for fingers, mice and touchpads.
On Samsung's Note line, the pens can be used to write, highlight and draw. The screens also sense when the mouse hovers over the screen, providing an equivalent to the hovering mouse cursor on the PC. However, few third-party applications have been modified to take full advantage of the pens.
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