For common ear infections, antibiotics are not required


Ear infections are common but do not require a course of antibiotics. In treating pain, a better alternative in most cases of middle ear infection are over-the-counter painkillers such as paracetamol and ibuprofen, said draft guidance from the National Institute for Health and Care Excellence (NICE).


The painful inflammation and a build-up of fluid behind the eardrum is a condition known as otitis media is usually experienced by children and young people. Around 1 in every 4 children (up to the age of 10) have at least one middle ear infection. While symptoms typically last for 3 days, they can continue up to 7 to 8 days in some cases.

Evidence reviewed by NICE indicates that without being prescribed antibiotics, around 60% of children with symptoms of a middle ear infection show signs of improvement, including less pain within a day.

Antibiotic Resistance

"We are all too well aware of the dangers we are facing with antibiotic resistance, so it is vital these medicines are only used when they are effective", said Professor Gillian Leng, deputy chief executive, and director of health and social care at NICE.

She continued, "The evidence shows antibiotics are not needed by most children and young people with middle ear infections. We must make sure the people who need them are given them, but routine prescribing in all cases isn't appropriate."

However, when symptoms do not improve after three days or when a burst eardrum leads to a discharge of fluid also, antibiotics should remain an option in some cases, as mentioned in guidelines.

"Many toddlers and children with this type of ear infection will get better within a few days by managing their pain with paracetamol or ibuprofen at home. It's important that they receive the right dose of painkiller at the right time", said Dr. Tessa Lewis, chair of the common managing infections guidance committee.

"If they don't improve within a few days, the draft guidance advises GPs consider a backup antibiotic prescription. This approach should help reduce the over-use of antibiotics for this common ear infection," Lewsi added.


"Ear infections can be horrible – and distressing, particularly for children and parents whose children are in pain – but they usually clear up on their own without antibiotics, so we welcome this draft NICE guidance today", said Professor Helen Stokes-Lampard.

She also adds, "If symptoms do persist for more than a few days, we will continue to encourage patients to seek advice from their pharmacist or GP – and this draft guidance retains the option of providing antibiotics as a backup treatment in these circumstances."