The goals of treatment are to eliminate the infection, and prevent hearing loss and other complications.
Antibiotics are generally used to treat ear infections in children under 2 years old, but these medications only work against bacterial infections. If the infection is caused by a virus, the antibiotics will not be effective. The only certain way to tell if the infection is caused by bacteria is to perform a myringotomy and culture the middle ear fluid, which are not frequently done.
In recent years, doctors have come to realize that antibiotic use for any reason causes bacteria to develop resistance to the antibiotic used. These resistant bacteria can then cause new infections in a child or be passed to family members or other children. Antibiotic resistance is a serious problem—particularly when, unlike most cases of otitis, the infection is serious or life threatening. Experts feel that our best protection against running out of antibiotics is to reduce prescribing these drugs for illnesses that are likely to get better on their own without treatment. Since many children with otitis will be much improved within 2 days—even without antibiotic treatment, reducing the use of antibiotics in children with otitis is an important health goal worldwide.
Many experts now believe that the risk of antibiotic treatment may be greater than its benefit for many children 2 years and older with an ear infection or suspected ear infection. In these children, symptoms of infection will often subside just as quickly without an antibiotic. A pain reliever is frequently all that older children need to recover fully from an ear infection.
It is important to keep in mind that antibiotics can cause a number of side effects. Nausea, stomach pain, and diarrhea are common. Also, there is a risk of having an allergic reaction to the antibiotic.
The doctor may prescribe an antibiotic if symptoms continue for more than a few days or worsen. Some doctors will give parents a prescription for antibiotics, but instruct them not to use the antibiotic unless pain or fever persists beyond an agreed-upon number of days.
When an antibiotic is prescribed, it is important that you carefully follow the dosage recommendations. Failure to finish the medication can make it less effective in the future. Sometimes the antibiotic initially prescribed does not clear the infection, and another medication may be recommended. Be sure to go to a follow-up visit with the doctor to determine whether the infection is resolved or requires further treatment.
Other medications that can help treat otitis media include nasal sprays or antihistamines in children with allergic rhinitis.
Treatment involves the following:
About antibiotic use and resistance. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/getsmart/community/about/index.html/URI/ear-infection.html. Accessed November 16, 2016. Accessed September 27, 2017.
Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM . Updated May 17, 2016. Accessed September 27, 2017.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
...(Click grey area to select URL)
Updated May 12, 2017. Accessed September 27, 2017.
Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx. Updated February 22, 2013. Accessed September 27, 2017.
10/12/2006 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM : Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006;296(10):1235-1241.
11/30/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM : Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161-2169.
Last reviewed September 2018 by
EBSCO Medical Review Board
Marcie L. Sidman, MD
Last Updated: 9/17/2014