Doctors shouldn't prescribe antibiotics routinely for children with middle ear infections, say Australian experts.
They don't reduce the pain within 24 hours and have potential side-effects such as rash, diarrhoea or vomiting.
The recommendation is one of 61 released on Wednesday by Choosing Wisely Australia, in the second round of its campaign identifying tests, treatments and procedures that may be unnecessary and could cause harm to patients.
The initiative aims to ensure healthcare resources are being used most effectively.
Fourteen medical colleges, societies and associations have each come up with a list of "5 things clinicians and consumers should question" relating to their area of expertise.
They include surgeons, nurses, dermatologists, ophthalmologists, physiotherapists, hospital pharmacists and palliative care specialists.
The recommendations include appropriate use of imaging and screening, and improving end of life and palliative care, while 15 per cent focus on antibiotics and their over-use.
"Middle ear infection is a common reason for children aged two to 12 years to present to their GP, and we recommend against routine use of antibiotics for this age group," says Dr Frank R Jones from the Royal Australasian College of General Practitioners.
As well as potential side-effects, he noted antibiotic use promotes bacterial resistance.
The guidelines differ for infants under six months, and for indigenous children who are at higher risk of complications.
SOME 'CHOOSING WISELY' RECOMMENDATIONS
* don't initiate or continue medicines to prevent disease in patients who have a limited life expectancy
* don't order chest x-rays in patients with uncomplicated acute bronchitis
* don't routinely do a pelvic examination with a Pap smear
* don't recommend the use of medicines with less than 30mg of codeine for mild to moderate pain
* don't use feeding tubes in patients with advanced dementia, use oral assisted feeding
* don't use CT scan for the evaluation of appendicitis in children and young adults, ultrasound is the preferred first approach
* don't order a colonoscopy as a screening test for bowel cancer in people at average or slightly above average risk, use faecal occult blood screening instead
Read the lists at www.choosingwisely.org.au.
