Most ear infections are caused by viruses that don't respond to antibiotics. (CBC)

Children with ear infections should not be routinely prescribed antibiotics, a Canadian medical group advised Tuesday.

The Canadian Pediatric Society's new recommendations on treating ear infections suggest doctors watch and wait before treating most ear infections with antibiotics in healthy children over six months old.

Almost all children will have at least one ear infection by the time they are five years old, but the infections are usually not serious or contagious, according to the society. The infections usually start on about the third day of a common cold, leading to symptoms such as:

• Unexplained fever.
• Difficulty sleeping.
• Tugging or pulling at the ears.
• Overall irritability.

Some ear infections are caused by viruses, rather than bacteria that respond to antibiotics, said Dr. Joan Robinson, author of the statement published this week in the journal Paediatrics & Child Health.

Antibiotics have a downside, such as causing diarrhea and allergic reactions. The pediatric society changed its policy because of pathogens' growing resistance to antibiotics.

Preventing antibiotic resistance

"Overuse of antibiotics is leading to resistance and the day may come when we no longer have oral antibiotics available for treatment of common infections," Robinson said.

Generally, doctors should wait 48 hours to see if symptoms last before turning to their prescription pad.

Before that, children may be treated with an analgesic such as acetaminophen, Robinson said, adding that 95 per cent of the time, the acetaminophen works as well as antibiotics for those with an ear infection.

That means that if every child with an ear infection gets antibiotics, then "you're treating 15 children to benefit one," said Robinson, a pediatric infectious-diseases physician at Stollery Children's Hospital in Edmonton.

Prevention tips for parents

Before the new guideline was released, it was recommended that if a doctor diagnosed an ear infection, then antibiotics should be prescribed.

But avoiding antibiotics doesn't mean there's no point taking a child to the doctor if he or she has a cold and signs of an ear infection or a fever over 39 C, the society said.

The group also recommended these ways to prevent ear infections:

• Breastfeed newborns.
• Avoid bottle feeding a baby who is lying down.
• Refrain from using a pacifier too often.
• Avoid exposure to cigarette smoke.
• Immunize children with the influenza and pneumococcal conjugate vaccine that helps protect against pneumonia and meningitis at the recommended age.
• Practise and preach excellent hand hygiene.
• Limit daycare exposure in very young children to reduce the risk of upper respiratory tract infection and therefore ear infections.

Amada Estabillo's daughter has only used antibiotics once in her 2½ years, when they were prescribed in hospital. A few days later, the family doctor said she didn't really need them, which left an impression.

"I think it's probably better to avoid them if you can," Estabillo said. "But I can understand, if you had a kid who was constantly having the same thing, wanting to get rid of it and try something that maybe would work."

With files from The Canadian Press