Antibiotics for acute otitis media in children


  • PP Glasziou,

    Professor of Evidence Based Practice, Corresponding author
    1. The University of Queensland, School of Population Health, Herston, QLD, AUSTRALIA
    • PP Glasziou, Professor of Evidence Based Practice, School of Population Health, The University of Queensland, Mayne Medical School, Herston Road, Herston, QLD, 4006, AUSTRALIA.

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  • CB Del Mar,

  • SL Sanders,

  • M Hayem



Acute otitis media is one of the most common diseases in early infancy and childhood. Antibiotic use for acute otitis media varies from 31% in the Netherlands to 98% in the USA and Australia.


The objective of this review was to assess the effects of antibiotics for children with acute otitis media.

Search strategy

We searched the Cochrane Controlled Trials Register, MEDLINE, Index Medicus (pre 1965), Current Contents and reference lists of articles from 1958 to January 2000.

Selection criteria

Randomised trials comparing antimicrobial drugs with placebo in children with acute otitis media.

Data collection and analysis

Three reviewers independently assessed trial quality and extracted data.

Main results

Ten trials were eligible but only seven trials, with a total of 2,202 children, included patient-relevant outcomes. The methodological quality of the included trials was generally high. All trials were from developed countries. The trials showed no reduction in pain at 24 hours, but a 28% relative reduction (95% confidence interval 15% to 38%) in pain at two to seven days. Since approximately 80% of patients will have settled spontaneously in this time, this means an absolute reduction of 5% or that about 17 children must be treated with antibiotics to prevent one child having some pain after two days. There was no effect of antibiotics on hearing problems of acute otitis media, as measured by subsequent tympanometry. However, audiometry was done in only two studies and incompletely reported. Nor did antibiotics influence other complications or recurrence. There were few serious complications seen in these trials: only one case of mastoiditis occurred in a penicillin treated group.

Reviewer's conclusions

Antibiotics provide a small benefit for acute otitis media in children. As most cases will resolve spontaneously, this benefit must be weighed against the possible adverse reactions. Antibiotic treatment may play an important role in reducing the risk of mastoiditis in populations where it is more common.

Plain language summary


Children's middle ear infections usually settle quickly without antibiotics, but antibiotics may help when the infection is prolonged

Acute otitis media is a short-term inflammation of the middle ear caused by viral or bacterial infection. Symptoms include ear pain and high fever. It is one of the most common health problems in infancy and childhood. The review of trials found that most children recovered within 24 hours with or without antibiotics. The review also found that antibiotics provide a small benefit. About 17 children have to take antibiotics to prevent one child having some pain after two days. However, adverse reactions to antibiotics (such as diarrhea) are common.