Antibiotic Stewardship and Pediatric Ear Infections
Andrea R. Gravatt, MD, FAAP, FAWM, Professor of Pediatric Medicine, University of Washington School of Medicine (retired status), Clinical Professor of Pediatric Medicine, Elson S. Floyd College of Medicine, Washington State University (retired status)
Antibiotic stewardship is the careful use of antibiotics, ensuring they are prescribed when needed while avoiding unnecessary exposure. In pediatric ear infections, this can mean treating some children with antibiotics while recommending watchful waiting for others.
Key Takeaways
Antibiotics can be used to treat infections caused by bacteria but have no effect against viruses.
Acute otitis media can involve bacteria, viruses, or both, and not every ear infection requires an antibiotic.
For some children with mild acute otitis media, clinical guidelines support watchful waiting before starting antibiotics.
Using the right antibiotics helps to reduce unnecessary side effects and stops antimicrobial resistance from developing.
Getting an accurate diagnosis is the first thing necessary if suitable treatment is to be determined.
Frequently Asked Questions
Do all childhood ear infections need antibiotics?
1
No. Some cases of acute otitis media can improve without antibiotics. Treatment depends on factors such as the child's age, symptoms, exam findings, and illness severity.
Do antibiotics work for viral ear infections?
2
Antibiotics work against bacteria, not viruses. Acute otitis media may involve bacteria, viruses, or both, which is why an accurate diagnosis matters.
Why might a doctor wait before prescribing antibiotics?
3
For some children with mild acute otitis media, clinical guidelines support watchful waiting while symptoms are managed and the child is monitored.
What is antibiotic stewardship?
4
Antibiotic stewardship means using antibiotics only when needed and, when treatment is necessary, selecting the appropriate medication, dose, and duration.
References
Venekamp RP, Sanders SL, Glasziou PP, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2023;11:CD000219.
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964-e999.
Castelli Gattinara G, Bergamini M, Simeone G, et al. Antibiotic treatment of acute and recurrent otitis media in children: an Italian intersociety Consensus. Italian Journal of Pediatrics. 2025;51:50.
Gerber JS, Jackson MA, Tamma PD, Zaoutis TE. Antibiotic Stewardship in Pediatrics. Pediatrics. 2021;147(1):e2020040295. Reaffirmed September 2025.
Centers for Disease Control and Prevention. The Core Elements of Outpatient Antibiotic Stewardship Programs. 2025.
Watch the Future in Review Podcast on Antibiotic Resistance
To learn more about the impact of antibiotic use in society, watch this enlightening podcast featuring Caitlin Cameron, CEO of OtoNexus, interviewed by FiRe COO Berit Anderson. Click the link below!
OtoNexus Featured in MedTech Outlook Magazine as Top Infection Control Solution Providers
Learn More About The Impact of Antibiotic Therapy
Early-life antibiotics increase the risk of allergy in adulthood. 50 Immunity
Duration of antibiotic treatment for acute otitis media and variability in prescribed durations across two large academic health systems. Journal Pediatric Infectious Disease Society.
Association of Infant Antibiotic Exposure with Childhood Health Outcomes - Mayo Clinic Proceedings, November 15, 2020
2013 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians - https://pediatrics.aappublications.org/content/131/3/e964
AMR Action Fund - Strengthens and accelerates the research and development of antibiotics
The antibiotic revolution should be more focused - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751913/
Antibiotic Resistance - https://www.sciencedirect.com/science/article/pii/S1876034116301277
Self-medication and antibiotic resistance: Crisis, current challenges, and prevention - https://www.sciencedirect.com/science/article/pii/S1319562X17300049
U.S. Action to Combat Antibiotic Resistance - https://www.cdc.gov/drugresistance/us-activities.html
Center for Disease Control (CDC) Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States Executive Summary - https://www.cdc.gov/mmwr/preview/mmwrhtml/00031393.htm
Otitis media and its consequences: beyond the earache, The Lancet Infectious Diseases Volume 10, Issue 3, March 2010, Pages 195-203, https://www.sciencedirect.com/science/article/abs/pii/S1473309910700128
Association Between Use of Multiple Classes of Antibiotics in Infancy and Allergic Disease in Childhood. JAMA Pediatrics, December 2019. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2757360
The Microbiome, Antibiotics and the Health of the Pediatric Population. EC Microbiol 2016 March 2016, Volume 3, Issue 1, Pages 388-390 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933318/
Decreased Antibiotic Susceptibility of S pneumoniae Strains. March 19, 2020, Infectious Disease Advisor