Antibiotics 'Not Needed' for Common Ear Infection

Peter Russell

September 22, 2017

Parents who take a poorly child to the GP with a common ear infection should not expect a course of antibiotics, says the health watchdog.

Draft guidance from the National Institute for Health and Care Excellence (NICE) says treating pain with over-the-counter painkillers such as paracetamol and ibuprofen is a better alternative in most cases of middle ear infection.


The condition, known as otitis media, causes painful inflammation and a build-up of fluid behind the eardrum and is commonly experienced by children and young people. It is estimated that around 1 in every 4 children have at least one middle ear infection by the time they are 10.

Symptoms typically last for 3 days but can continue for 7 to 8 days in some cases.

After reviewing the available evidence, NICE found that around 60% of children with symptoms of a middle ear infection show signs of improvement, including less pain, within 24 hours, even if they have not been prescribed antibiotics.

Antibiotic Resistance

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, says in a statement: "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.

"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."

The guidelines say antibiotics should remain an option in some cases, including when symptoms don't improve after 3 days or when a burst eardrum leads to a discharge of fluid.

Dr Tessa Lewis, chair of the managing common infections guidance committee, says in a statement: "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.

"If they don’t improve within a few days, the draft guidance advises GPs consider a back-up antibiotic prescription.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


Responding to the new draft guidelines, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, says in a statement: "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.

"GPs are making great strides in reducing prescriptions for antibiotics for many conditions, so it's important that we get the message out to patients that antibiotics are not always the answer to minor, self-limiting conditions such as ear infections, colds and sore throats.

"Growing resistance to antibiotics is a major global threat – and these important drugs must be used appropriately in order to minimise this, and to ensure that antibiotics continue to work when people really need them, now and in the future.

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

The draft guidance is out for consultation until 19th October.


National Institute for Health and Care Excellence (NICE)

Royal College of GPs


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