Should I give my child antibiotics when he/she has an ear infection?

One of the commonest symptoms in childhood is earache. It can be very frightening for your child to wake up in intense pain, it may be the first time she has really felt a severe pain. As GPs and nurses we see a lot of earaches and we often wonder whether we are doing the right thing!

We know that a lot of ear infections in children are associated with colds. These infections are caused by viruses which are not killed by antibiotics. The virus infection causes catarrh fluid to build up behind the ear drum in just the same way that catarrh builds up in the nose. This catarrh and the associated inflammation causes pain.

It is easy for us to give a child antibiotics and feel that we are doing some good. But sometimes we think that we might be doing some harm.

Antibiotics have their problems.

• They can cause diarrhoea and rashes and sometimes more serious illness.
• Your child may be labeled as allergic to an antibiotic and then be deprived of a potentially life saving drug later when a more serious infection arrives.
• Meningitis is one such infection and penicillin is still the first medicine to be given.

We, at the Devonshire Lodge Practice feel it is such a difficult problem that we would like you to have up to date information about what is best for your child.

What evidence is there for antibiotics?

To help you and us, there has been a recent article in the British Medical Journal which has tried to pull all the evidence together from the research that has been done to try and answer the question.

The best evidence for questions such as this is to compare what happens if you treat with an active medicine, in this case antibiotic, with what happens if an inactive or dummy medicine is given. This is because a significant number of people will get better with the dummy medicine alone.

The findings were very interesting and reached several simple conclusions:

1. Six research studies were found looking at children from 7 months to 15 years old.
2. 60% of children treated with dummy medicine were free of pain after 24 hours.
3. 60% of children treated with antibiotic were free of pain after 24 hours!
4. Antibiotics did reduce the pain of earache in some children who still had pain at 2-7 days.
5. If children were given antibiotics, they were twice as likely to suffer from diarrhoea, vomiting or rashes.

Only 1 in 17 children benefit

The researchers calculated that to prevent one child from experiencing earache 2 to 7 days after the start of the infection, 17 children would need to be treated by antibiotics immediately.

16 times out of 17 your child will get better just as quickly without antibiotics.

It is interesting to note that in the Netherlands general practitioners do not treat ear infections with antibiotics. It is very reassuring to know that they do not see children suffering complications as a result.

It is safe and appropriate to treat children with earache with paracetamol. They do not normally need antibiotics.

What can I do to help my child with earache?

• Make sure you always have some Paracetamol syrup (e.g. Calpol) in the house
• Give full doses to your child every 4-6 hours, no more than 4 times in 24 hours.
• If your child does not have asthma, you can also use ibuprofen syrup as an additional painkiller.

Doses of Paracetamol or Calpol :

• 3-5 months 60mg
• 6-11 months 120mg 
• 1-5 years 250mg
• 6-12 years 500mg