Get Smart: Know When Antibiotics Work

Ear Infection

Get Smart: Know When Antibiotics Work: Ear Infection


Antibiotics are not recommended to help treat many ear infections. Your healthcare professional will be able to determine what kind of ear infection you or your child has and if antibiotics would help. Learn more below about two of the three main kinds of ear infections: otitis media with effusion and acute otitis media. Visit CDC's Healthy Swimming website to learn more about otitis externa (swimmer’s ear).


Otitis Media with Effusion

Otitis media with effusion, or OME, is a buildup of fluid in the middle ear without signs and symptoms of infection (pain, redness of the eardrum, pus, fever). The most common reasons for this fluid buildup include

  • Allergies
  • Irritants such as cigarette smoke
  • Previous respiratory infections
  • Drinking while laying on your back
  • Changes in air pressure due to travel or elevation changes

OME almost always goes away on its own and will not benefit from antibiotics. After a respiratory tract infection has gone away, fluid may remain inside the ear and take a month or longer to go away. Sometimes this fluid can become infected, leading to acute otitis media (AOM). OME is more common than AOM.

Acute Otitis Media

Acute otitis media, or AOM, is the type of ear infection that affects the inside of the ear and can be painful. AOM is often caused by bacteria, but can also be caused by viruses. The bacteria that usually cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The viruses that most commonly cause AOM are respiratory syncytial virus (RSV), rhinoviruses, influenza viruses, and adenoviruses.

AOM may improve with antibiotics, but they are not always necessary since not all AOM is caused by bacteria.

Risk Factors

There are many things that can increase your risk for OME or AOM, including:

  • Age (children younger than 2 years are at higher risk)
  • Daycare attendance
  • Drinking from a bottle while laying down
  • Season (ear infections are more common during fall and winter)
  • Exposure to air pollution or secondhand smoke

Signs and Symptoms

Children with OME do not act sick and will not have any obvious symptoms, although temporary problems with hearing may be present. Symptoms more commonly associated with AOM include:

  • Pulling at ears, especially with children
  • Excessive crying
  • Fluid draining from ears
  • Sleep disturbances
  • Fever
  • Headache
  • Problems with hearing
  • Irritability, especially with infants and toddlers
  • Difficulty balancing

When to Seek Medical Care

See a healthcare professional if you or your child has any of the following:

  • Temperature higher than 100.4 °F
  • Discharge of blood or pus from the ears
  • Symptoms that have not improved or have gotten worse after being diagnosed with an ear infection

If your child is younger than three months of age and has a fever, it’s important to always call your healthcare professional right away.

Diagnosis and Treatment

Ear infections can be diagnosed with a special instrument called an otoscope, which is used to look inside the ear at the eardrum. Your healthcare professional can also perform a special test using the otoscope to see if fluid has collected behind the eardrum. If OME is present, fluid may be visible, but there will be no signs of infection. If there are signs of infection, then AOM may be present.

Your healthcare professional will consider several factors when determining if antibiotics are needed for an ear infection: age, illness severity, certainty a bacterial infection is present, and options for follow-up. Since ear infections will often get better on their own without antibiotic treatment, your healthcare professional may decide to wait a few days before prescribing antibiotics. When an ear infection is caused by a virus, antibiotic treatment will not help it get better and may even cause harm in both children and adults.

If symptoms continue to last for more than one month for OME or 2 days for AOM, you should schedule a follow-up appointment with your healthcare professional.

Symptom Relief

Rest, over-the-counter medicines and other self-care methods may help you or your child feel better. For more information about symptomatic relief, visit the Symptom Relief( section of this website or talk to your healthcare professional, including your pharmacist. Remember, always use over-the-counter products as directed. Many over-the-counter products are not recommended for children of certain ages.


There are steps you can take to help prevent getting an ear infection, including:

  • Avoid smoking and exposure to secondhand smoke
  • Keep you and your child up to date with recommended immunizations
  • Breastfeed your baby for 12 months or more if possible
  • Bottle feed your baby in the upright position