Will antibiotics help relieve symptoms in babies and toddlers?

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.

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.

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.

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.

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.

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.

It is 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).

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.