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We have new advice today for parents and doctors dealing with ear infections. It's a common problem for kids, and one of the most common solutions is the use of antibiotics. The American Academy of Pediatrics says the antibiotics are being used too much. Here's NPR's Rob Stein.

ROB STEIN, BYLINE: Every year, millions of parents take their children to the pediatrician for ear infections, and most end up going home with antibiotics. In fact, ear infections are the leading reason kids get antibiotics.

DR. RICHARD ROSENFELD: Parents - if their child is up all night screaming and tugging the ear, they want something to make the child feel better.

STEIN: But ear specialist Richard Rosenfeld says most kids would get better on their own, often just in a few days. And there can be some real downsides to using antibiotics: They can cause upset stomachs, allergic reactions and other problems. And they can create superbugs - infections that are getting harder and harder to cure.

ROSENFELD: Bacteria that do survive the antibiotic get tough, and next time you get an ear infection or any other type of infection, they're harder to manage.

STEIN: So the American Academy of Pediatrics is issuing new guidelines designed to get doctors to use antibiotics only when they're absolutely needed. The first thing they say is, make sure the child really has an ear infection.

ROSENFELD: There are dozens of reasons an ear can hurt. In this guideline, we say: Listen, if you're not sure of the diagnosis, don't even think about giving an antibiotic. Please, forget about it.

STEIN: The only way to know for sure is to take a close look at the eardrum.

ROSENFELD: If that eardrum is bulging - if it's pushed outwards, looks like it wants to pop - that is a very, very accurate sign of an ear infection.

STEIN: But even a lot of kids who really do have ear infections don't necessarily need antibiotics if there aren't any severe symptoms, like lots of pain or a high fever.

ROSENFELD: You don't have to freak out, as a parent. They tend to go away on their own, quite often ,with just some pain medicine.

STEIN: But there are some kids who definitely should get antibiotics: younger kids who have infections in both ears; or any kid who has really bad symptoms, like a fever of at least 102.2; or kids whose eardrums are ruptured.

ROSENFELD: If you have a severe infection, no point discussing it further. Those children are going to get antibiotics. And the reason is, they get the most benefit.

STEIN: Other experts praise the new guidelines. But some, like Beth Wald of the University of Wisconsin, worry they might make some doctors too hesitant to use antibiotics for kids who really need them. [POST-BROADCAST CORRECTION: Dr. Wald's first name is Ellen, not Beth.]

DR. ELLEN WALD: When the diagnosis is correct, then antibiotic treatment is never wrong. Kids tend to recover more often, and they recover more quickly, if they're treated appropriately with antibiotics.

STEIN: And, Wald says, getting kids better faster can make a big difference for lots of parents.

WALD: There is so much pressure for both parents to be working outside the home, and it's just complicated when your child is sick; besides which - you know, there's always parental anxiety and concern when their child is sick.

STEIN: Rosenfeld stresses that doctors are free to figure out the best way to go for each child. They can always send parents home with what's called a safety net, or wait-and-see prescription.

ROSENFELD: And say, you know, the odds are very great that your son or daughter is going to get better in the next three days. Hold onto this antibiotic. Give some pain medicine the first day or two. And if they're not better after three days, then we do want you to let us know and start the antibiotic. But if they are better, just throw it out - and they'll do fine.

STEIN: And the new guidelines make one other important point: They recommend ways parents can protect their kids from ear infections in the first place, such as breast-feeding and keeping them away from cigarette smoke.

Rob Stein, NPR News.

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