Middle ear infection, or acute otitis media, is one of the most commonly diagnosed infections during the preschool years. If your child develops an upper respiratory infection that lasts for one to three days prior to the onset of ear pain, she may have the beginnings of a middle ear infection.

Ear infections are the most common reason for which physicians prescribe antibiotics in children.

In the past decade, there has been a significant increase in antibiotic resistance to certain bacteria, which is now a very important public health concern.

To help prevent the unnecessary prescription of antibiotics for ear infections, we recommend parents and providers consider the following, based on national, evidence-based guidelines:

• To properly diagnose an ear infection, the provider must be able to clearly see the ear drum.
• Ear pain should be treated most often with ear drops and ibuprofen.
• If an ear infection is confirmed, providers and parents may consider a “wait-and-see prescription,” where instead of giving the child antibiotics immediately, the parents delay filling the antibiotic prescription for 48 hours. If the pain improves and the fever is gone, parents may elect not to fill the prescription.
• High fever, infections in both ears, or severe fussiness may be important reasons to start antibiotics immediately.

According to published research on the “wait-and-see” antibiotic prescription method:

• Approximately two-thirds of parents do not fill the antibiotics prescription and their child recovers uneventfully.
• Routine follow-up after diagnosis of ear infections is unnecessary and not recommended.
• Reducing unnecessary use of antibiotics may prevent vomiting, diarrhea, rashes and resistance to further infections for children and family members.

David Spiro, M.D., M.P.H.
Medical Director, Doernbecher Emergency Department
Associate Professor of Emergency Medicine and Pediatrics
OHSU Doernbecher Children’s Hospital