Health & wellness

MD Mama

Ear infections don’t necessarily require antibiotics

Adapted from the MD Mama blog on

Your child has an earache. You are worried it is an ear infection. You call the doctor. After all, he needs antibiotics, right? Maybe not.

We have a problem of antibiotic overuse in our country and many bacteria are getting smarter and stronger as a result. Because an ear infection is the diagnosis that kids in the US are most commonly prescribed antibiotics for, the American Academy of Pediatrics tried in 2004 to encourage doctors to rethink their prescribing habits.

It turns out that ear infections don’t necessarily need antibiotics. Many are caused by viruses. Many will get better without antibiotics. And overuse of antibiotics can have side effects.


The guidelines were supposed to help doctors make better decisions, but many doctors don’t follow them. So the AAP is trying again. It has reissued guidelines, with clarifications and additions. Here is what your doctor is supposed to do:

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Check to see if it’s really an infection. Not only can the common cold or tooth problems cause earaches, you can also get pain from having fluid in the middle ear, something called Otitis Media with Effusion. Your doctor is supposed to look for the signs of a true infection: ear pain that comes on suddenly and persists, and an eardrum that is full or bulging with pus behind it, that doesn’t move when you blow air into it, or is draining pus.

Ask about and treat pain. Whether or not there is an infection that needs antibiotics, there is an earache that needs soothing — so your doctor should be talking to you about how to help your child’s pain.

If there really is an infection, figure out if it’s severe. Again, sounds obvious, but it’s important for deciding if antibiotics are needed. A severe infection is one where there is a lot of pain, the child seems ill, or there is a fever of 102.2 degrees Fahrenheit or higher.

Decide if antibiotics are necessary. Here is who should get antibiotics:


Anybody with a severe infection

Anybody with other health problems that put them at risk of complications

Children under 6 months old

Children 6-23 months who have infections in both ears

If antibiotics aren’t definitely needed, talk with parents about waiting and watching for 48-72 hours. I give parents a prescription, but tell them not to fill it unless the child gets worse or doesn’t get better in 2-3 days. Most don’t need to fill the prescription. Pain medication and some patience very often do the trick.


To make this work, parents need to understand what they are looking for, be able to get the prescription if needed, be able to reach the doctor if they have questions — and the doctor needs to be able to reach them easily to check on the child.

If an antibiotic is prescribed, it should be Amoxicillin. To fight antibiotic resistance, it’s important to use the one that will kill only the bacteria likely to cause the infection. For ear infections, that’s Amoxicillin, unless the child’s allergic, just had Amoxicillin in the past month, has conjunctivitis too, or doesn’t get better in 48-72 hours.

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