Ear infections often clear up on their own within three days
A Cochrane review found antibiotics did not reduce children’s ear pain at 24 hours, though NICE names groups who may benefit more.
Most ear infections clear up within three days, the NHS says, though symptoms can sometimes last up to a week.
Ear infections are very common, particularly in children.
Where antibiotics come in
NICE’s guideline on antibiotics for acute middle ear infection says most children and young people get better within three days without them.
It says children and young people who are very unwell, have symptoms and signs of a more serious illness or condition, or are at high risk of complications should be offered an immediate antibiotic prescription. It also describes a group who may be more likely to benefit from antibiotics: those of any age with discharge from the ear, and those under two with infection in both ears.
A Cochrane review published in November 2023 found that, compared with a placebo, antibiotics did not reduce the number of children with pain at 24 hours, by which time 60% had recovered or improved, and only slightly reduced it in the days that followed. Antibiotics also slightly reduced the number of children with a ruptured eardrum, and with infection in the other ear.
But for every 14 children treated, one had a side effect such as vomiting, diarrhoea or a rash that would not have occurred without antibiotics.
Its authors said there was not enough information to know whether antibiotics reduce rare complications such as mastoiditis, an infection of the bones around the ear. For most children with mild disease in high-income countries, they wrote, “an expectant observational approach seems justified”.
For pain, the NHS lists painkillers such as paracetamol or ibuprofen, though children under 16 should not take aspirin, it says. It says there is no evidence that decongestants or antihistamines help.
Signs that need an urgent call
The NHS says to ask for an urgent GP appointment or get help from NHS 111 now if someone with symptoms of an ear infection also:
- feels generally unwell
- has a very high temperature, or feels hot, cold or shivery
- has swelling around the ear
- has fluid coming out of the ear
- has a change in hearing or new hearing loss
- feels sick or is being sick, feels dizzy or has a severe sore throat
- is a child under 12 months old with earache in both ears
- has diabetes, or a heart, lung, kidney or neurological condition
- has a weakened immune system, for example because of chemotherapy
It says to see a GP if earache has not got better after three days, if a child under 12 months old is thought to have an ear infection, or if infections keep coming back. It says a pharmacist can give children aged 1 to 17 the same treatments as a GP.
