Health Library Should I Give My Child Antibiotics for an Ear Infection?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's suggestion.

Key points in making your decision

Recent medical research is changing the way many doctors treat ear infections. Consider these points when making your decision whether to use antibiotics:

• Your doctor may suggest that you wait 48 hours before giving your child antibiotics, because most ear infections clear up on their own.¹ One study showed that a "wait-and-see" approach cut the use of antibiotics by 76%. The majority of parents were satisfied with the results.²
• If after 48 hours your child is not improved and needs antibiotics, you may have to wait at least another 48 hours for the antibiotics to take effect.
• Your doctor may decide that your child needs to take antibiotics right away:
  • When your child is younger than 2, because the risk of complications is higher for very young children.
  • When your child is very ill, for example when he or she is dehydrated, or when a fever is more than 102 °F (38.89 °C).
  • When your child has other medical conditions such as cleft palate or repeat infections that could put him or her at risk for complications from an ear infection.

What is an ear infection?

An ear infection, also called otitis media, is inflammation or infection of the middle ear. Otitis media often occurs along with a cold or other upper respiratory infections. Almost all children have at least one ear infection before age 7.

Ear infections are most common in young children because they have shorter, more horizontal eustachian tubes, which are more easily blocked than those of older children and adults. When the eustachian tube is blocked, fluid builds up, creating a breeding ground for bacteria or viruses.

Pus develops as the body tries to fight the infection. More fluid collects and pushes against the eardrum, causing pain and sometimes a loss of hearing. Fever lasts about 1 to 2 days; pain and crying usually last for 3 to 4 hours. After that, most children have some pain on and off for up to 4 days. Young children may have pain that comes and goes for up to 9 days.

What causes ear infections?

Most ear infections are caused by bacteria that multiply in the fluid built up behind the eardrum. However, viruses also can lead to ear infections. The respiratory syncytial virus (RSV) is a leading cause, followed by influenza (flu) viruses. That's why antibiotics do not always work for ear infections, because they can kill bacteria but not viruses.

How do I know if my child has an ear infection?

After a couple of bouts, most parents can recognize an ear infection when their child starts running a fever and tugging at his or her ears just after getting over a cold. However, the only way to know for sure that an ear infection is causing these symptoms is a visit to your doctor. An exam with a pneumatic otoscope will tell you for certain.

If an ear infection is present, the eardrum will bulge and look red or yellow. Also, the eardrum will not move freely when slight air pressure is applied with the pneumatic otoscope.

Are there special circumstances in which children should take antibiotics for ear infections instead of waiting?

There are situations where antibiotics should be given without waiting. These situations involve:

• Children who have serious chronic conditions, such as heart disease or cystic fibrosis.
• Children who are seriously ill with severe pain.
• Children who have a high fever.
• Children who are dehydrated.
• Children younger than 2 years of age, who are sometimes given antibiotics right away because they may be at risk for other illnesses.

For more information, see the topic Ear Infections.

Your choices are:

• Wait 48 to 72 hours to see whether the ear infection clears on its own.
• Give your child antibiotics.

The decision about whether to give your child antibiotics for an ear infection takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After finishing it, you should have a better idea of how you feel about giving your child antibiotics for an ear infection. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA=Not applicable

Use the following spaces to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to give or not give your child antibiotics for an ear infection.

Check the box below that represents your overall impression about your decision.

Return to the topic Ear Infections.

Citations

1. White DR, Choo DI (2005). Otitis media. In RE Rakel, ET Bope, eds., Conn's Current Therapy, pp. 223–225. Philadelphia: Elsevier Saunders.

2. Little P, et al. (2001). Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ, 322(7282): 336–342.

Author:	Debby Golonka, MPH	Last Updated: February 28, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Charles M. Myer, III, MD - Otolaryngology
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.