Otitis Media in Children

Comments from Expert Advisory Committee

  • Acute otitis media (AOM) is very common in children.
  • The cause of the majority of AOM cases is viral.
  • Illness resolves over 3 days in 80% without antibiotics
  • AOM is usually self-limiting even if it from a bacterial cause.
    • It is often difficult to distinguish between viral or bacterial otitis media (both are often present at the same time).
  • Pain relief and parent information (see “Patient Information”) are the most important factors.
  • Treat pain with adequate and regular simple analgesia.
    • Regular paracetamol or ibuprofen at correct maximum dose for weight (see dosing tables for paediatric analgesia).
  • Healthcare professionals can use their clinical judgement to decide when dosing by weight is more appropriate (e.g. for underweight children) as per the dosing charts.

Consider no antibiotics in the majority of children.

  • Children aged ≥ 2 years or children < 2 years with only 1 ear affected and no otorrhoea.
    • Consider no antibiotics, or, a back-up prescription to be used if no improvement in 3 days or if symptoms worsen.
  • Those that may benefit from immediate antibiotics are children aged <2 years with bilateral infection or those with otorrhoea secondary to a perforated eardrum.
    • Other options in these patients include no antibiotic or a back-up prescription to use if symptoms worsen or fail to improve within 3 days.
  • Advise parents:
    • Most children and young adults get better within 3 days without antibiotics.
    • Symptoms last for about 3 days but can last for up to 1 week.
    • To return if symptoms worsen rapidly or significantly.

Overall evidence on antibiotics in acute otitis media:

  • Most children will get better within 3 days without antibiotics.
  • Antibiotics make little difference to the number of children whose symptoms improve.
  • Antibiotics make little difference to the time it takes for the symptoms to improve.
  • Antibiotics have minimal impact on recurrence, short term hearing loss or eardrum perforation.
  • Complications from otitis media i.e. mastoiditis are rare with or without antibiotics.
    • We would need to treat 2504 patients <20 years with antibiotics to prevent 1 case of mastoiditis.
  • Complications from antibiotics including diarrhoea and nausea are relatively common.

Evidence for other medications in otitis media

  • Decongestants, antihistamines and corticosteroids have not been shown to be effective in AOM.


If antibiotics deemed clinically indicated:

Drug Dose Duration +/- Notes
1st choice option     7-day courses may be reserved for those with more severe or recurrent infection.
Amoxicillin Refer to dosing table 5 days
Penicillin Allergy    
Clarithromycin Refer to dosing table 5 days
2nd choice option: if symptoms worsen on a first-choice antibiotic taken for at least 2 to 3 days.
Co-amoxiclav Refer to dosing table 5 days

Acute Otitis Media in Children treatment table 02 2022.pdf (size 389.5 KB)

Safe Prescribing (visit the safe prescribing page)

Reviewed August 2022

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