Ear Infections: Antibiotics Often Not Needed

Most Children With Middle Ear Infections Get Better on Their Own, Study Finds

Medically Reviewed by Laura J. Martin, MD on November 15, 2010
From the WebMD Archives

Nov. 16, 2010 -- The best treatment for many children with middle ear infections may be no treatment at all, a review of the research confirms.

The analysis found antibiotics to be “modestly” more effective than just treating symptoms with pain medication. But use of antibiotics was also commonly associated with side effects like diarrhea and rash.

Researchers say the review, published in the Journal of the American Medical Association, shows the merit of a watch-and-wait approach to managing ear infections.

Pros and Cons of Antibiotics

Current treatment guidelines give doctors the choice of prescribing antibiotics right away or observing children for up to three days with only pain management to see if they get better on their own.

The new analysis found that in most cases they do.

Based on their review of more than 100 studies published over the last decade, the researchers were able to quantify the risks and benefits of treatment with antibiotics.

They estimated that for every 100 otherwise healthy children with uncomplicated middle ear infections, about 80 could be expected to improve without antibiotics within about three days.

An additional 12 children could be expected to improve during this time if all were treated with antibiotics, but three to 10 would develop a treatment-related rash and five to 10 would get diarrhea.

“It is clear that the number of kids who would benefit from treatment with antibiotics is about the same as the number who develop treatment-related side effects,” researcher Tumaini Coker tells WebMD.

Parents OK With No Treatment

A pediatrician with Mattel Children’s Hospital UCLA and a researcher with the nonprofit research group RAND Corporation, Coker says in her experience most parents are willing to try the watch-and-wait approach if their child’s pain is adequately managed.

Brooklyn otolaryngologist Richard Rosenfeld tells WebMD he often gives parents a "safety net" antibiotic prescription to be filled only if the child gets worse or does not improve within a few days.

He says most of the prescriptions never get filled.

Rosenfeld chairs the otolaryngology department at Brooklyn’s Long Island College Hospital.

“I find that parents are delighted to avoid antibiotics when they can, because they are aware of the side effects,” he says. “Parents want their children to feel better and sleep through the night. For that you need ibuprofen, not antibiotics.”

Less treatment would result in big savings to the health care system, the researchers say.

Antibiotics are prescribed more for ear infections than for any other childhood illness. A 2006 government survey found the average cost for treating ear infections to be $350 per child, totaling $2.8 billion a year.

When Antibiotics Are Needed

Not every child with an ear infection will get better without antibiotics. Rosenfeld says children who benefit most from treatment include:

  • Those with infections in both ears
  • Children with ruptured eardrums
  • Children who are 6 months old or younger
  • Those who have severe ear pain and/or high fever

The analysis was commissioned by the U.S. Agency for Healthcare Research and Quality to assist the American Academy of Pediatrics (AAP) in revising its existing treatment guidelines for middle ear infections.

Among the other major findings:

  • The evidence suggests that generic antibiotics work just as well as brand name ones. The researchers concluded cost savings would be substantial if more doctors prescribed amoxicillin rather than pricier antibiotics.
  • Although there is no specific test to confirm or rule out ear infection, looking inside the ear with an otoscope is a key component of diagnosis.

Show Sources


Coker, T.R. Journal of the American Medical Association, Nov. 17, 2010; vol 304: pp 2161-2169.

Tumaini R. Coker, MD, MBA, pediatrician, Mattel Children’s Hospital UCLA; researcher, RAND Center for Adolescent Health Promotion, David Geffen School of Medicine UCLA, Los Angeles.

Richard Rosenfeld, MD, chairman of the otolaryngology department, Long Island College Hospital, Brooklyn, N.Y.

News release, RAND Corporation.

News release, Journal of the American Medical Association.

American Academy of Pedaitrics and American Academy of Family Physicians: “Diagnosis and Management of Acute Otitis Media."

Agency for Healthcare Research and Quality, 2006 report on ear infection expenditures.

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