Ear infections are very common in children and can be caused by either bacteria or a virus. Doctors often prescribe antibiotics to treat bacterial infections. However, there are circumstances in which antibiotics may not be necessary, says Dr. David Hall, a double board-certified internal medicine and pediatrics doctor with Sharp Rees-Stealy Medical Group.
"Antibiotics are not needed in all cases of ear infections, as the majority can actually resolve on their own in a few days, especially in children who are over 2 years old," says Dr. Hall. "It's important to note that antibiotics are not effective in treating ear infections caused by viruses."
Signs of ear infection are usually pain, especially on the first day, or fever. Other symptoms, particularly in young children, can include pulling at the ears, crying, discharge from the ears, hearing problems or trouble sleeping.
If you think your child has an ear infection
Call the doctor if you suspect your child has an ear infection.
"We usually try to see the patient the same day or next day, as a diagnosis can be made with an otoscopy, or ear exam," says Dr. Hall. "An in-office evaluation is needed to diagnose a bacterial middle ear infection by confirming a bulging eardrum. If this finding is not seen, it is much less likely to be a bacterial infection and antibiotics can often be avoided."
In otherwise healthy children over the age of 2 years, there are some circumstances when it is reasonable to take a "wait and see" approach, as many of these infections can resolve without antibiotics. Dr. Hall recommends giving your child an over-the-counter medication, such as an infants' or children's version of acetaminophen or ibuprofen to help relieve pain.
"Children whose ear infections are managed with observation at home and pain relief often recover just as well as children who receive antibiotics right away," he says. "However, your child should see a doctor if symptoms do not improve in two or three days, or if they get worse at any time."
Avoiding unnecessary use of antibiotics
Dr. Hall cautions against treating your child's ear infection with antibiotics if they are not needed because antibiotics can have side effects, including vomiting, diarrhea and allergic reactions.
In addition, "antibiotics not only destroy healthy bacteria, but also promote the growth and proliferation of antibiotic-resistant strains of bacteria, which make it harder to treat infection in the future," he says.
When treatment with antibiotics is needed
Infants and some children may need antibiotics right away, and immediate treatment is important if a bacterial infection is suspected, according to Dr. Hall.
These children include:
- Infants 6 months old or younger
- Babies ages 6 months to 2 years, who have moderate to severe ear pain or infection of both ears
- Children ages 2 or older who have a fever of 102.2° F or above, have persistent pain for more than 48 hours, or have infection of both ears
- A cleft palate
- Down syndrome
- An immune disorder
- A cochlear implant
At Sharp Rees-Stealy, we want to empower you to make well-informed choices about treatments for your child. That's why we've made it our priority to support our doctors in helping you make smart and effective decisions by participating in Choosing Wisely®.
Choosing Wisely, an initiative of the ABIM Foundation, educates patients and doctors on selecting the most effective treatment available and avoiding unproductive, costly procedures. Sharp Rees-Stealy is the only medical group in Southern California to participate in this national campaign.