Ear infection , also called acute otitis media, is practically a rite of passage of childhood. Fluid build-up in the middle ear causes inflammation, pain, and sometimes fever, which are traditionally treated with antibiotics. In fact, doctors in the US write about 15 million antibiotic prescriptions each year for ear infections.

Studies have found, though, that most ear infections will resolve on their own within 2-3 days without antibiotics. This finding combined with concerns that overuse of antibiotics is leading to antibiotic-resistant bacteria, have prompted doctors to rethink the need for antibiotics to treat ear infections.

Yale researchers set out to determine if a “wait-and-see” approach to antibiotic use for ear infections would lead to less use of antibiotics without causing further pain for children. Among parents advised to give antibiotics only if their children’s symptoms did not improve after 48 hours, 38% gave antibiotics, compared with 87% of parents instructed to give the drugs immediately. In addition, symptoms did not differ between the two groups of children. This study is in the September 13, 2006 Journal of the American Medical Association .

About the Study

Researchers from Yale-New Haven Hospital enrolled 283 otherwise healthy children, ages 6 months to 12 years, who came to the emergency department with ear infections. All of the children’s parents were given a prescription for an antibiotic before being divided into two groups based on the prescription instructions:

  1. The wait-and-see prescription (WASP) group–do not fill the prescription unless your child is no better or worse 48 hours after today’s visit
  2. The standard prescription (SP) group–fill the prescription and give the antibiotic to your child after today’s visit

All patients received ibuprofen and ear drops to use as needed for pain relief. Researchers compared the percentage of parents who filled the prescription, as well as the children’s symptoms in the two groups. This data was collected during three follow-up phone calls.

Significantly fewer parents in the WASP group (38%) filled the antibiotic prescription than in the SP group (87%). Parents in the WASP group who gave their children antibiotics cited fever, ear pain, and fussy behavior as their reasons for giving the antibiotics. Overall, though, the rates of fever, ear pain, rash, ear discharge, and return medical visits were not different between the two groups and no serious events occurred in any children in the study. Diarrhea , a side effect of antibiotics, was more common among children in the SP group.

This study was not blinded; parents knew which group they were assigned to and this knowledge could have affected their evaluation of their children’s symptoms. However, the researchers who conducted the follow-up phone calls were blinded to group status.

How Does This Affect You?

In agreement with previous research, this study found that it is safe to avoid, or at least delay, giving antibiotics to otherwise healthy children with uncomplicated cases of otitis media. The wait-and-see strategy remains controversial, though, as most pediatricians are trained to prescribe antibiotics for ear infections and many parents expect a prescription when they bring a distressed child to the doctor. However, the risks of routine antibiotic use–namely bacterial resistance and drug side effects–do not necessarily outweigh its benefits, especially if most children recover quickly on their own.

If your child has an ear infection, talk with your doctor about alternatives to antibiotics. Ask about ear drops and other means of pain relief. Also, be sure you know the symptoms that warrant a return to the doctor, including high fever or vomiting. The wait-and-see approach is not appropriate in these situations:

  • Infants younger than six months
  • History of recurrent ear infections
  • Structural concerns such as cleft palate
  • Genetic conditions such as Down syndrome
  • Underlying illness such as immune system disorder