Antibiotics for reducing the pain of middle ear infection (acute otitis media) in children

Acute otitis media (AOM) is common in children, causing pain and deafness. Though AOM usually resolves without treatment, it is often treated with antibiotics. This review found that antibiotics are not very useful for most children with AOM. Antibiotics marginally decreased the number of children with pain at 24 hours (when most children were better), only slightly reduced the number of children with pain in the few days following and did not reduce the number of children with hearing loss (that can last several weeks). However, antibiotics seem to be most beneficial in children younger than two years of age with bilateral AOM (infection in both ears), and in children with both AOM and otorrhoea (discharge from the ear). There was not enough information to know if antibiotics reduced rare complications such as mastoiditis (an infection of the bones around the ear). Some guidelines have recommended a management approach in which certain children are observed and antibiotics taken only if symptoms remain or have worsened after a few days. This review found no difference between immediate antibiotics and observational treatment approaches in the number of children with pain three to seven days after assessment. All of the studies included in this review were from high-income countries. Data from populations in which the incidence of AOM and risk of progression to mastoiditis is much higher are lacking. Antibiotics caused unwanted effects such as diarrhoea, stomach pain and rash, and may also increase resistance to antibiotics in the community. It is difficult to balance the small benefits against the small harms of antibiotics for most children.