The Canadian Paediatric Society has upheld its position that doctors should continue to "watch and wait" before treating most children's ear infections with the drugs.  One expert says the statement guidelines are a bid to reduce unnecessary antibiotic use in children.

The CPS re-affirmed its stance in an updated statement released on Friday.

The updated statement echoes previous recommendations that doctors look for signs that an ear infection is relatively severe, before prescribing the patient antibiotics.

"Doctors should look for definitive signs that it is a severe ear infection," Dr. Joan Robinson, co-author of the statement and chair of the CPS Infectious Disease and Immunization Committee, said in a statement.

"It's important to be looking for a bulging eardrum, rather than just a red eardrum before prescribing antibiotics."

Robinson said even in cases when the eardrum is bulging, many children will get better just as quickly with pain relief, as they would with antibiotics. As well, side effects are common with antibiotics, she said. Some side effects associated with antibiotics include diarrhea and rashes. As well, there are general concerns that overuse of antibiotics can result in increased antibiotic resistance.

"Most children will have relief with just acetaminophen or ibuprofen," Robinson said. "However, the message to parents is, if your child has a cold and then develops signs of an ear infection that does not improve with pain relief, take them to the doctor to check it out."

The statement says that antibiotic treatment is recommended for children with ear infections who have a high fever, who are moderately to severely ill or who have "very severe" ear pain, or who have already been "significantly ill" for at least 48 hours.

"For all other cases, parents can be provided with a prescription for antibiotics to fill if the child does not improve in 48 hours, or the child can be reassessed if this occurs," the statement says.

Dr. Marvin Gans, an associate professor in the department of paediatrics at the University of Toronto, said most children won’t end up needing antibiotics.

"Statistically, two out of three kids will not need antibiotics, and one out of three will," he told in a phone interview. "The whole concept is to try and decrease the use of antibiotics in children who will do fine without them."

Ear infections are common, particularly with children between the ages of six months and three years. Most ear infections begin after a child has had a cold for a few days. Symptoms of ear infections include unexplained fever, difficulty sleeping, tugging at the ears, and overall irritability.