Will antibiotics help relieve symptoms in babies and toddlers?

Middle ear infections (otitis media) will usually clear up within a few days, with or without treatment. But antibiotics can speed up recovery in children under two years of age who have an infection in both ears. They may also help if the infected ears are leaking fluid.

Middle ear infections can cause earache and fever. These symptoms can be treated with painkillers like acetaminophen (paracetamol) or ibuprofen. Whether antibiotics are an appropriate treatment will depend on what other symptoms the child has. Antibiotics can only help treat bacterial infections. Children with specific symptoms benefit from them, but antibiotics will hardly help in children without these symptoms.

Research on antibiotics for acute middle ear infections

Researchers from the Cochrane Collaboration, an international network of researchers, looked for studies that could help show the advantages and disadvantages of antibiotic treatment of acute middle ear infections in babies and toddlers. They found 13 reliable studies involving a total of about 3,400 children. The studies randomly divided the children into two groups and then compared them with each other. One group of children took antibiotics and the other did not.

The researchers wanted to know what effect antibiotics had on pain and fever after one to seven days of treatment. They were also interested in whether children who took antibiotics had fewer complications like hearing problems, or the spread of the infection to the other ear or the bone behind the ear. The possible side effects were also investigated.

Antibiotics are often ineffective

The researchers found that antibiotics often didn't speed up recovery. Within 24 hours of taking antibiotics, many children's earache hadn't gone away any quicker than in children who didn't take antibiotics. The antibiotics provided only slight pain relief when used a little longer. In numbers: After two to three days

about 22 out of 100 children who did not take antibiotics still had an earache, and
about 15 out of 100 children who used antibiotics still had an earache.

In other words, because of the antibiotics an additional 7 out of 100 children did not have an earache after two to three days.

Antibiotics can also reduce the risk of the eardrum bursting (a perforated eardrum):

about 3 out of 100 children who did not take antibiotics had their eardrum burst, and
about 1 out of 100 children who used antibiotics had their eardrum burst.

In other words: antibiotics prevented a burst eardrum in about 2 out of 100 children. But burst eardrums are generally not a very serious problem. The hole in the eardrum is usually small and heals on its own within a few days or weeks. It is more serious if the eardrum bursts several times or if the hole is large.

Antibiotics can help in some children

Some children may benefit more from antibiotics than others: These include children who are under two years old and have an infection in both ears, and those of all age groups who are leaking pus from their ear. Both symptoms are signs of a bacterial infection, which can be treated effectively with antibiotics.

After three to seven days, out of children under two years of age with acute middle ear infection in both ears

55 out of 100 children who did not take antibiotics still had an earache or fever, and
30 out of 100 children who used antibiotics still did.

So the antibiotics worked in 25 out of 100 of these children.

They also helped children who had fluid leaking from their ears.

60 out of 100 children who did not take antibiotics still had fever or an earache,
but only 24 out of 100 who used antibiotics did.

So antibiotics helped in 36 out of 100 children who had fluid leaking from their ears.

Side effects of antibiotics

It's important to also consider possible side effects when looking at the benefits of antibiotics. Antibiotics can cause nausea, diarrhea and rashes. Around 5 out of 100 children who use antibiotics had one of these side effects. Using antibiotics too often also leads to the development and spread of bacteria that no longer respond to antibiotics (“resistant” bacteria) .

Watchful waiting makes sense in most cases

In most children it's best to wait for two to three days in order to see whether the symptoms improve on their own, and then decide whether to use antibiotics. This can help avoid side effects. Painkillers will relieve the pain more quickly than antibiotics. If you take a "watchful waiting" approach, it's a good idea to go to back to the doctor for a check-up.

Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2015; (6): CD000219.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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