Antibiotics for acute middle ear infection in children

This fact box will help you to weigh the benefits and harms of antibiotics for children with an acute middle ear infection. The information and numbers are based on the best scientific evidence currently available.

This fact box was developed by the Harding Center for Risk Literacy.

What is an acute middle ear infection?

An acute middle ear infection is an infection of the middle ear. People with the infection might have severe earache, a fever, and pus or blood oozing from their ear [1].

What are antibiotics?

Antibiotics are among the most important drugs for treating infectious diseases. However, they work only against bacteria, not against viruses.

Who might consider treatment with antibiotics for an acute middle ear infection?

Children who have acute middle ear infections that don’t go away or get worse [1].

What are the alternative treatment options? 

Instead of antibiotics, painkillers can be given to relieve pain. Closely watching whether the child’s symptoms get worse before giving an antibiotic is another possibility [1].

Fact box_antibiotics_middle ear infection_EN

What does the fact box show?

This fact box compares the advantages and disadvantages of antibiotics and placebo for children who had an acute middle ear infection.

The table may be read as follows:

24 out of 100 children who took a fake pill still felt pain 4 to 7 days after they were diagnosed. 18 out of 100 children who took antibiotics still felt pain after the same amount of time.

The numbers in this fact box are rounded off. They are based on 13 medical studies that looked at 3,401 children [1].

What else is important?

Using antibiotics too often may make bacteria resistant to antibiotics. This means that antibiotics are no longer able to kill bacteria or to slow them down in spreading. An especially big problem is when bacteria change genetically so that antibiotics no longer work as well  [2].

Do the results provide proof (evidence) for the benefits and harms of the treatment?

Overall, the evidence is very reliable. The results listed in the fact box will probably stay the same in the future [1].

Last update

June 2016


Information within the fact box was obtained from the following sources:

[1] Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2015(6):CD000219. doi: 10.1002/14651858.CD000219.pub4.

[2] BMG (ed.). Die wichtigsten Begriffe zum Thema Antibiotika-Resistenzen. 2015. Available from: https://www.bundesgesundheitsministerium.de/themen/praevention/antibioti....

Fact boxes

The idea of fact boxes was developed by Lisa Schwartz and Steven Woloshin. In several studies they demonstrated that fact boxes were effective tools for informing the general public about benefits and harms of medical interventions. Read more in the overview.


Terms of use: All fact boxes of the Harding Center for Risk Literacy and accompanying materials are licensed under a Creative Commons BY-NC-ND 4.0 license (attribution - non-commercial - no derivatives - 4.0 international).


Technical Terms

It is not always easy to evaluate (health) risks. To facilitate risk comprehension we have summarized and explained technical terms and criteria in a glossary.

A-D   E-G   H-K   L-N   O-R   S-Z

Helpful Questions for Life in an Uncertain World

We identified a couple of questions that help you face uncertainty and facilitate your understanding of risks across different situations.

to the questions...