How effective is antibiotic treatment for middle ear infection?

Middle ear infections can follow a cold and may involve viruses, bacteria or both. Antibiotics target bacteria; they do not treat a viral cause. A clinician considers ear examination findings, pain, fever, discharge, age and whether one or both ears are affected before recommending immediate treatment, observation or review.

Pain and fever may improve before the pressure or blocked hearing settles. Fluid can remain behind the eardrum after infection and may temporarily affect hearing, so a slow return to normal does not always mean treatment has failed.

Give or take the antibiotic exactly as prescribed and complete the course if it has been started. Use age-appropriate pain relief only as advised, and never put drops, oils or objects into the ear unless a clinician recommends them.

Arrange a review if pain or fever is not improving within the advised timeframe, if symptoms return, or if hearing remains reduced after the infection settles. Keep children hydrated and observe feeding, sleep and alertness.

Seek urgent care for swelling or redness behind the ear, a new facial weakness, severe headache, unusual drowsiness, stiff neck, repeated vomiting or a child who is difficult to wake. Prompt assessment is also needed for severe pain, worsening fever or fluid mixed with blood.

Ask whether the ear findings suggest bacteria, when improvement should start, which pain medicine is suitable, and when hearing or persistent fluid should be checked. For a child, ask what changes in feeding or behaviour require a call.