Antibiotics for Ear Infections in Children

When you need them—and when you don’t

Many children get ear infections. The infections are usually in the middle ear behind the eardrum. They may be caused by bacteria or by a virus. Doctors often treat bacterial infections with antibiotics. Antibiotics are strong medicines that kill bacteria.

Infants and some babies and children do need antibiotics.

But using antibiotics too often can be harmful. Here’s why:

In most cases, antibiotics are not needed.

  • They do not work for ear infections caused by viruses.
  • They do not help the pain.
  • Usually, viral infections and many bacterial infections go away on their own in two to three days, especially in children who are over two years old.

First, call the doctor and treat the pain.

If you suspect your child has an ear infection, you should call the doctor’s office and describe the symptoms. Usually, your doctor should ask you to wait a few days before bringing your child in.

The main sign of an ear infection is pain, especially on the first day. Or, a child may have a fever.

Start by giving your child an over-the-counter pain reliever, such as:

  • acetaminophen (Infants’ or Children’s Tylenol and generic).
  • ibuprofen (Children’s Motrin and generic).

Antibiotics do not relieve pain in the first 24 hours. They only have a small effect on pain after that.  So, pain relievers are an important treatment, and usually they are the only treatment needed.

Give most children two or three days to get better.
Ask the doctor if antibiotics are necessary or if a “wait and see” approach may work. Children whose ear infections are managed this way recover just as well as children who get antibiotics right away. However, your child should see a doctor if symptoms do not improve in two to three days or if they get worse at any time.

Antibiotics can have side effects.
When children take antibiotics at the first sign of an ear infection, they are more likely to have vomiting, diarrhea, and allergic reactions because of the medicine. Also, antibiotics can kill “friendly” germs in the body and cause other problems like diarrhea.

Over-use of antibiotics is a problem.
Antibiotics can help drug-resistant bacteria grow. These bacteria are harder to kill. They can cause illnesses that are harder to cure and more costly to treat. This increases the risk of complications and side effects. The resistant bacteria can also infect other people.

Antibiotics can be a waste of money.
Prescription antibiotics can cost as much as $50 to treat a mild ear infection in the average two-year-old. Drug-resistent infections can lead to more doctor visits and medicines that cost more.

When is treatment with antibiotics needed?
If the infection is very painful and lasts more than a few days, chances are it is a bacterial infection.

Sometimes immediate treatment is important. These children often need antibiotics right away:

  • Infants six months old or younger.
  • Babies ages six months to two years, who have moderate to severe ear pain.
  • Children age two or older who have a fever of 102.2 Fahrenheit or higher.
  • Children with another condition that could make it harder to heal, including children with:
    • A cleft palate
    • Down syndrome
    • An immune disorder
    • A cochlear implant

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

Developed in cooperation with the American Academy of Family Physicians.