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NICE ‘bans’ antibiotics for majority of common ear infections

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Paracetamol or ibuprofen should be given instead of antibiotics for most common ear infections, according to draft guidance from the National Institute for Health and Care Excellence.

The draft guideline, published today, makes recommendations for treating acute otitis media, the middle ear infection that is commonly experienced by children and young people.

“Once finalised, our advice will support healthcare professionals to decide whether or not to use antibiotics”

Gillian Leng

NICE said the evidence it had reviewed found 60% of children with symptoms of otitis media would show signs of improvement, such as less pain, within 24 hours without the need to take antibiotics.

As a result, the institute said healthcare professionals should help children and young people to manage their symptoms with pain relief.

However, the draft guidance specifies some groups of patients who may need antibiotics immediately, such as those who are very unwell or have symptoms of a more serious illness.

If a patient experiences discharge from their ear following a burst ear drum, they should be offered antibiotics immediately or as a delayed prescription, said NICE.

Should their symptoms significantly worsen or not improve within three days, they can collect their antibiotics, it noted.

The draft guidance is out for consultation until 19 October. Stakeholders and members of the public are invited to comment on the proposed advice.


Gillian Leng

Professor Gillian Leng, NICE’s deputy chief executive and director of health and social care, said: “Once finalised, our advice will support healthcare professionals to decide whether or not to use antibiotics.

“We are all too well aware of the dangers we are facing with antibiotic resistance, so it is vital these medicines are only used when they are effective,” she said.

“The evidence shows antibiotics are not needed by most children and young people with middle ear infections,” she said. “We must make sure the people who need them are given them, but routine prescribing in all cases isn’t appropriate.”

Dr Tessa Lewis, chair of NICE’s managing guidance committee on common infections, advocated only considering “back-up” antibiotics if an improvement in symptoms was not seen within a few days.

“This approach should help reduce the over-use of antibiotics for this common ear infection,” said Dr Lewis.

She added: “Many toddlers and children with this type of ear infection will get better within a few days by managing their pain with paracetamol or ibuprofen at home.

“It’s important that they receive the right dose of painkiller at the right time,” she noted.

Acute otitis media is particularly common in infants between six and 15 months old and an estimated 25% of children will have at least one middle ear infection before they reach 10 years old.

helen stokes lampard blog image

helen stokes lampard blog image

Helen Stokes-Lampard

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, noted that ear infections could be “horrible”, particularly for children and parents, but welcomed the draft NICE guidance.

“It’s important that we get the message out to patients that antibiotics are not always the answer to minor, self-limiting conditions such as ear infections, colds and sore throats,” she said.

She added: “The college has worked with Public Health England to develop the TARGET antibiotics toolkit to support GPs and other prescribing healthcare professionals to prescribe appropriately.”

  • 1 Comment

Readers' comments (1)

  • GREAT!
    NICE make the decision on antibiotics then had responsibility & accountability, perhaps for a childs life, over to the real professionals.
    I can see longer queues at A & E

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