Choosing Wisely - Ear infection

Children with a middle ear infection

Most children older than 2 years won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days. However, many children younger than 2 years may need antibiotics to treat the infection.

Antibiotics won’t help relieve your child’s ear pain. Whilst a child’s ear pain will be of concern to their parents or carers, studies show that 6 out of 10 children will have no ear pain after the first 24 hours without any treatment (antibiotics or pain relief).

Pain relief medicines (such as paracetamol or ibuprofen) can help to relieve the symptoms of an ear infection, and will usually only be needed for a short time.

If your child’s symptoms don’t improve after a few days, or their symptoms get worse, see your doctor.

Antibiotics for middle ear infections in children

Antibiotics are recommended for children with middle ear infections who:

• are younger than 6 months
• are younger than 2 years old with an infection in both ears or fluid leaking out of their ear (called ‘otorrhoea’)
• have a fever (a temperature of 38.5°C or higher) and are vomiting.

Babies and infants younger than 6 months old

Infants younger than 6 months old who have ear infections (with or without fever or vomiting) will usually be prescribed an antibiotic. Your doctor will usually ask to see your baby again in 24 hours.

Children aged 6 months to 2 years

Your doctor will advise you on how to relieve the symptoms of a middle ear infection. Your doctor may ask to see your child after 24 hours, or contact you to ask how they are. If your child’s symptoms don’t improve after 24 hours, your doctor may prescribe antibiotics.

Children aged 2 years or older

Your doctor will advise you on how to relieve the symptoms of a middle ear infection. If your child’s symptoms don’t improve in 2 days, your doctor will usually examine your child again and may prescribe antibiotics if necessary.

Adults with a middle ear infection

Most adults won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days.

Your doctor can provide advice about how to relieve your symptoms. If your symptoms don’t improve in 2 days, your doctor will usually examine you again and may prescribe antibiotics.

Paracetamol, ibuprofen or aspirin can help relieve the pain caused by an ear infection.

Further information

Ear infections: Health Navigator

It’s OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.

You can also download this information as a pdf (401 KB).

Adapted from NPS MedicineWise (2016), Medicines and treatments for a middle ear infection. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.