"The decision on whether to give young children antibiotics to treat ear infections has been swinging from one extreme to the other as conflicting clinical trials have pushed pediatricians first toward widespread use of antibiotics then toward a watch and wait approach in which most infections seem to clear up on their own. Two new trials reported Wednesday in the New England Journal of Medicine are nudging the pendulum back toward treatment of the infections known formally as acute otitis media especially for the youngest children. They show that the use of antibiotics in infants under age  is only modestly effective and reduces the duration of symptoms by only a small amount but it prevents relapses and progression of the disease. The trials are indicative of a benefit to treatment of acute otitis media in children specifically when the diagnosis is certain said Dr. Wilbert Mason an infectious diseases specialist at Childrens Hospital Los Angeles who was not involved in the study. The reduction of symptoms was marginal he said but they were less likely to have a relapse or to have persistent signs of infection at the end of therapy. The findings confirms the current guidelines for treating children under age  said Dr. Al Lieberthal of USCs Keck School of Medicine who is in charge of the American Academy of Pediatrics Committee that prepared the guidelines. The guidelines will be revised in light of the new studies however to tighten the definition of acute otitis media he added.   There have been at least a dozen previous clinical trials studying the use of antibiotics in ear infections known formally as acute otitis media. These have given mixed results according to Dr. Anthony S. Fauci director of the National Institute of Allergy and Infectious Diseases because of poor study design and especially because of poor diagnosis of the subjects conditions. In many cases the children had something that looked like otitis media but really wasnt he said. The new studies had really precise criteria to be eligible for enrollment which makes them substantial studies. In one of the studies Dr. Alejandro Hoberman of the University of Pittsburgh School of Medicine and his colleagues studied  children age  months to  months with stringently defined acute otitis media. Half were given the antibiotic amoxicillinclavulanate for  days and half a placebo. In the second study Dr. Paula A. Tahtinen of Turku University Hospital in Finland  and her colleagues studied  children age  months to  months half of whom were given the antibiotic and half a placebo for seven days. In the Pittsburgh study  of the children receiving an antibiotic had a resolution of symptoms by day seven compared with  of those receiving a placebo. But  of those receiving an antibiotic had a sustained resolution of symptoms compared with  of those who got the placebo. The Finnish study looked for continuing symptoms which is known as treatment failure. It found that at the end of seven days treatment failure occurred in . of those who received antibiotic compared with . of those who received a placebo. That sounds like a big improvement said Dr. Richard Rosenfeld chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn who also helped prepare the AAPs guidelines but all it means is that if the eardrum looked nasty the treatment failed. Eardrums sometimes take weeks to months to recover. That finding to me is a bit of a dubious way to say that everybody needs treatment. Experts noted however that certain children should receive immediate antibiotic treatment regardless of age. That includes those who are under  months of age those who have a draining ear caused by a ruptured eardrum those with severe symptoms early on and those with infections in both ears. But physicians are reluctant to give antibiotics indiscriminately because of the side effects which include diarrhea yeast infections oral thrush allergic reactions and resistant bacteria. You pay a price for a little bit of improvement Rosenfeld said."