Does every ear infection need antibiotics?
Updated: Jun 20, 2019
I recently had a friend ask me what she should do to help her 19-month toddler recover from an antibiotic course for a recurrent, mild ear infection. Her daughter was on her second round of antibiotics by that time, since the first course didn’t eradicate the pain and discomfort. I gave her some suggestions about how to rebuild her daughter’s gut flora, but her story got me thinking about how readily antibiotics are prescribed (and re-prescribed) for seemingly mild infections.
Ear infections are the number one reason that parents bring their young children in to see the doctor. Known as acute otitis media (AOM), ear infections remain the most common reason for which doctors prescribe antibiotics. Of course, antibiotics are sometimes needed for resolving severe bacterial infections and we would be in a poor state indeed if we did not have antibiotics in our medical arsenal. However, are antibiotics needed every time your child has an earache? The research clearly says, “no, you don’t.” Only bacterial infections respond to antibiotics. Research estimates that anywhere from 51 – 78% of ear infections are bacterial. That means that anywhere from 22 – 49% of infections are not going to be helped by antibiotics. These infections can be caused by viruses or even food allergies. And yet antibiotics are prescribed an overwhelming 97% of the time.
...anywhere from 22 - 49% of infections are not going to be helped by antibiotics
In 2013, the American Academy of Pediatrics re-issued similar guidelines and recommendations for the diagnosis and management of AOM to what they had suggested back in 2004. The Academy continues to recommend antibiotic therapy for bilateral AOMs, both severe and non-severe. However, for unilateral (where only one ear is affected), the Academy recommends antibiotics, or observation...with close follow-up. Meaning, parents can go home with a prescription in hand, but wait two to three days to fill it. They should go home and employ "watchful waiting" to see how the child does over the next 48-72 hours. Studies show that over 80% of children will "spontaneously recover," without any need for prescription antibiotics.  Not only does this reduce prescription costs, but more importantly, it also saves the child from unnecessarily disrupting their gut flora. As we know, suboptimal gut bacteria is linked to a host of illnesses and issues, not the least of which is a compromised immune system.
80% of children will spontaneously recover from an ear infection
A study conducted in 2010 showed that antibiotics are only modestly more effective than doing nothing, but come with greater side effects such as diarrhea, diaper rash, and of course, long-term destruction of the child's gut flora. [5,6] An older meta-analysis of studies done on the effectiveness of antibiotics concluded the same thing; researchers failed to find statistically significant differences in young children treated with antibiotics versus those treated with placebo.  It can take months, or longer, of active intervention to repopulate gut bacteria that has been decimated by antibiotics. And often times, another round has been prescribed before optimal levels are reestablished.
researchers failed to find statistically significant differences in young children treated with antibiotics versus those treated with placebo
Therefore, children ages 12 months to 12 years, without severe symptoms, i.e. a fever above 39C or 102.2F, a ruptured eardrum with drainage, or intense pain, can likely recover on their own, without the need for antibiotics. During this time, they should be comforted as needed and treated with pain medication for fussiness and discomfort.
I like to use an all-natural ear oil that contains garlic and mullein for both symptomatic and core relief, as garlic is a natural antibacterial and antiviral. Mullein is another powerful antiviral and anti-inflammatory herb with a millennia of historical support for its use. In children over one-year of age, a little turmeric powder mixed into raw honey is also a helpful remedy. (Do not give honey to children under one year of age).
 James, J. M. (2004). Common respiratory manifestations of food allergy: a critical focus on otitis media. Current allergy and asthma reports, 4(4), 294-301.
 Froom, J., Culpepper, L., Green, L. A., de Melker, R. A., Grob, P., Heeren, T., & van Balen, F. (2001). A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit. Report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN). The Journal of the American Board of Family Practice, 14(6), 406-417.
 American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media with Effusion. Otitis media with effusion. Pediatrics. 2004; 113: pp. 1412-1429.
 Rovers, M.M., Schilder, A.G., Zielhuis, G.A., & Rosenfeld, R.M. (2004). Otitis media. The Lancet, 363 (9407), 465-473.
 Coker, T.R., Chan, L.S., Newberry, S.J., Limbos, M.A., Suttorp, M.J., Shekelle, P.G., & Takata, G.S. (2010). Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. Jama, 304(19), 2161-2169.
 Del Mar, C.B., Paul, P.G., & Hayem, M. (1997). Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ, 314(7093), 1526.
 Damoiseaux, R.A., Van Balen, F.A., Hoes, A.W., & de Melker, R.A. (1998). Antibiotic treatment of Acute Otitis Media in Children Under Two years of age: evidence-based? Br J of Gen Pract 48 (437), 1861-1864.