Does an ear infection (otitis media) always need antibiotic treatment?
The common practice in this country (although not everywhere—Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. If you and the doctor decide to wait on antibiotic treatment, you can still treat fever and pain with acetaminophen (Tylenol) or ibuprofen (Motrin). There is also available a numbing ear drop that, when dripped down the ear canal onto the ear drum, directly relieves the pain there.
If you think about it, this newer understanding of the natural history of ear infections makes sense. Children have been contracting ear infections for many thousands of years, yet we have only had antibiotics for three-quarters of a century. The overwhelming majority of those children in the pre-antibiotic era must have recovered from the infection on their own.
You may have noticed that above I used the weasel words “not necessarily” in my statement regarding whether or not ear infections need prompt evaluation. There are a few times that they do. How can you know when that is? The answer is to look at your child in light of what else she is doing. She will have a fever and probably be fussy. But if she is alert, drinking fluids, and looks good otherwise, you can safely put off having her evaluated. On the other hand, if she is lethargic, glassy-eyed, and not taking fluids, then you should bring her in because those kinds of symptoms can be indicative of a more serious condition. If you decide to wait and see how your child does before bringing her to the doctor, how much time should you give it? Twenty-four hours is a reasonable amount of time to wait to see if the fever and pain resolve. If they do not, then it would be appropriate to bring your child to the doctor.
The American Academy of Pediatrics has revised their recommendations about treating ear infections to reflect this more nuanced approach. You can read the list of recommendations here, but the gist of it is that “watchful waiting” is a reasonable alternative to antibiotic therapy for children over 6 months of age, who do not appear seriously ill, and who do not have a temperature of over 102.2.
You can read more specifics about what causes ear infections here if you like.