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.