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GPs advised not to prescribe antibiotics for ear infection

Antibiotics should not be routinely prescribed for acute otitis media in children, as most will improve without them, NICE have advised in a new draft guideline.

Antibiotics will not significantly reduce pain in otitis media in the first 24 hours, so in most cases, GPs should not prescribe them, the draft advice says.

The draft guideline, which is out for consultation until 19 October, recommends that children over two years old with non-discharging acute otitis media should not be given antibiotics, or given a back-up prescription only.

All children presenting with an ear infection should be given paracetamol or ibuprofen for pain with patients advised about the normal course of otitis media.

If a delayed prescription is given, NICE recommends that GPs advise that an antibiotic is not needed straight away and explain when and how to use the prescription if it is needed.

Evidence reviewed by NICE in the guideline suggests that 60% of children will have less pain after 24 hours whether or not they are given antibiotics. There was also evidence to suggest that antibiotics made little difference to hearing loss in children with otitis media. 

The draft also recommends that children with discharge from a perforated eardrum and children under two years with an infection in both ears should be offered a delayed or immediate antibiotic prescription.

Those who are systemically unwell, have symptoms of a more serious condition or are at high risk of complication should be offered an immediate prescription and emergency referral considered if the child seems very unwell.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: ‘Once finalised, our advice will support GPs and healthcare professionals to decide whether or not to use antibiotics.

‘We are all too well aware of the dangers we are facing with antibiotic resistance, so it is vital these medicines are only used when they are effective.

‘The evidence shows antibiotics are not needed by most children and young people with middle ear infections. We must make sure the people who need them are given them, but routine prescribing in all cases isn’t appropriate.’

RCGP chair Professor Helen Stokes-Lampard said: ‘Ear infections can be horrible – and distressing, particularly for children and parents whose children are in pain – but they usually clear up on their own without antibiotics, so we welcome this draft NICE guidance today.’

Professor Stokes-Lampard said this comes as ‘GPs are making great strides in reducing prescriptions for antibiotics’ as part of the important fight against antibiotic resistance.

She added: ‘If symptoms do persist for more than a few days, we would continue to encourage patients to seek advice from their pharmacist or GP – and this draft guidance retains the option of providing antibiotics as a back-up treatment in these circumstances.’

Guideline in full

Offer paracetamol or ibuprofen to all children and young people with symptoms of acute otitis media in order to reduce pain

Consider either no antibiotic prescription or a delayed prescription in children and young people with symptoms of acute otitis media unless they are under two years of age and have an infection in both ears or if they have otorrhoea

  • Advise about the usual course of the infection if no antibiotics given
  • Explain how and when to use a delayed prescription

Consider either a delayed or immediate antibiotic prescription for children and young people with symptoms of acute otitis media and otorrhoea and children under two years of age with an infection in both ears

  • Prescribe in line with the NICE guideline on self-limiting respiratory tract infections

Offer an immediate antibiotic prescription to children and young people who are systemically very unwell, have signs of a more serious illness or are at high risk of serious complications due to pre-existing conditions

  • Refer for emergency care if they have signs or symptoms suggesting a severe systemic infection or an acute complication

Source: NICE


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