Otitis Media (being treated with antibiotics)

Advice intended for parents/carers taking their child home after seeing a healthcare professional

The middle ear is the small space behind the eardrum; this space is usually filled with air. Otitis media is an infection of the middle ear that causes inflammation and a build up of fluid, which can then become infected by bacteria or viruses. It is often extremely painful.


  • Earache
  • Fever may be present
  • Misery
  • Pulling, tugging or rubbing ear
  • Slight hearing loss

In most cases, the symptoms of a middle ear infection develop quickly and resolve in a few days. In some cases, pus may run out of the ear, this is the fluid that had built up behind the ear drum causing a small hole in eardrum, this tends to resolve with no intervention required.


The Eustachian tube is a small tube that links the middle ear to the back of the throat. It's main job is to regulate air pressure in the ear. Its other function is to drain any fluid or mucus that builds up. The common 'cold' can cause the Eustachian to become blocked, causing a build up of fluid or mucus.

When to seek further help:

If your child has any of the following:

  • Has blue lips
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Too breathless to talk/eat or drink
  • Becomes pale, mottled and feels abnormally cold to touch
  • Has a fit/seizure
  • Develops double vision or blurred vision

  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Develops swelling behind the ear or increasing pain/redness behind the ear
  • Severe headache persisting despite regular painkillers (ibuprofen and paracetamol) or worse on lying down / in the morning
  • Develops dizziness or is losing their balance
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle down with toys, TV, food, or picking up) - especially if they remain drowsy or irritable despite their fever coming down
  • Is complaining of a severe headache and neck stiffness/pain or discomfort with bright lights (photophobia)
  • Starts to vomit repeatedly
  • Develops a severe pain behind their eyes
  • Develops a squint (eyes pointing in different directions) or starts complaining about double vision or needs to cover up one eye to see or complaining of blurred vision
  • Develops weakness in an arm or leg
  • Is having breathing problems, such as rapid breathing, shortness of breath or labored breathing (drawing in of muscles below the lower ribs when they breathe in)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Has extreme shivering or complains of muscle pain
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Is getting worse or if you are worried

You need to contact the discharging ward urgently

If none of the above features are present

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111


Most middle ear infections are caused by viral infections and resolve with 3-5 days without treatment. Paracetamol or Ibuprofen can help ease the pain caused by the build up of fluid.

Antibiotics are usually considered if your child:

  • Is less than 2 years old with an infection in both ears
  • Has pus draining from the ear and fever
  • Has a serious health condition that makes them more vulnerable to complications

Treatment with intravenous antibiotics (given into a vein) is occasionally considered for extremely severe cases.

Some children who need intravenous antibiotics are admitted to hospital initially whilst the majority can be looked after at home. These children would come into hospital once a day for someone to look at them and for their antibiotics to be given.

The decision on when to change from intravenous to oral antibiotics (tablets or liquid) will be made by the medical team caring for your child. This will depends on how quickly your child responds to treatment (improvement in fever, pain and sometimes their blood tests) and whether your child has other health conditions. Antibiotics are usually given for a total of 5 days. You can give regular pain relief (Paracetamol or Ibuprofen) until any discomfort his improved.


Most children recover without any complications. Complications of middle ear infections are rare, but can be serious if they do occur. Most complications are due to the infection spreading to another part of the ear or head, including:

  • Mastoiditis (infection of the bone behind the ear)
  • Labyrinthitis (infection affecting the inner ear)
  • Meningitis (inflammation of the lining of the brain)

If you are concerned that your child's condition is getting worse (see table above), you should contact your discharging ward.

Call 999 for ambulance if you have serious concerns for your child.


It is not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition.

  • Ensure your child is up-to-date with their immunisations
  • Avoid exposing your child to smoky environments (passive smoking)
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