Antibiotics help children's ear infections get better faster

What the research found

A 2023 Cochrane review pooled trials that compared antibiotics with placebo or with watching and waiting in children with middle ear infections. It looked at pain over time and at side effects. Guidelines built on this kind of research do not recommend antibiotics for every child.

Guidance for mild cases is to treat pain first and wait. A review from 2013 said antibiotics can be put off in children aged two or older with mild symptoms. Australian hospital guidance says most acute symptoms settle within 24 hours. It suggests antibiotics if distress goes beyond 24 to 48 hours, or if the child is more unwell at the start. US health guidance says many ear infections get better without antibiotics.

Antibiotics are advised more firmly for younger or sicker children. A 2017 review recommended them for all children under two. Victorian health advice says babies six months or younger will generally need one. A 2024 meta-analysis found antibiotics cut the risk of mastoiditis, a rare complication, but caused side effects in about 1 extra child for every 23 treated.

What it doesn’t mean

• This does not mean antibiotics are useless. Severe infections, infections lasting more than 2 to 3 days, and infections in babies and very young children often need them.
• Antibiotics can cause side effects, so they are not a risk-free shortcut. If your doctor prescribes them, finish the course. Pain relief such as paracetamol is still an important part of care.
• See a doctor if your child is six months or younger, has a high fever or bad earache, has ear discharge, or is not improving after 48 hours. Also see one if they still seem to have trouble hearing after six to eight weeks.