An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study

Ear infections in children will often get better without needing to use antibiotics; the collected evidence from trials performed in several different countries has shown that most children with ear infections given Paracetamol suspension (such as Calpol) were better in a few days. In fact 17 out of 20 children got better in this way without the use of an antibiotic. In comparison if all 20 children took antibiotics only one extra child got better over the same period, and at present there is no way of knowing which one of the 20 given antibiotics would benefit. Also if the 20 children were all given antibiotics, one was likely to suffer a side-effect as a consequence (such as a rash, diarrhoea or vomiting).

Antibiotics did not reduce pain in the first 24 hours and there was also no difference in the likelihood of a further ear infection or hearing difficulty. In the Netherlands antibiotics have not been used routinely for some years for ear infections; they have less of a problem with antibiotic resistance than in this country.

In view of the above evidence we have changed our policy and no longer give antibiotics routinely for ear infections in children. We would recommend treatment with Paracetamol suspension, which will reduce pain and fever. It should be given at full dose until the earache is gone. If the ear infection persists, or the child is particularly unwell, then antibiotics may be tried. This will be discussed on an individual basis with you during your consultation with the doctor.