In most situations, children diagnosed with otitis media should be observed first before being treated with antibiotics.

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Many cases of otitis media improve on their own, so a period of watchful waiting is a common first step. By observing for 48 to 72 hours, clinicians can see if symptoms improve without antibiotics, which helps avoid unnecessary antibiotic use and its potential side effects and contributes to reducing antibiotic resistance.

During observation, focus on pain control and keeping the child comfortable with appropriate analgesics, fluids, and close follow-up. Antibiotics are reserved for situations where symptoms are more severe, the child is very young or at higher risk, or there is no improvement after the observation period. For example, immediate antibiotics may be favored for younger children, bilateral disease, high fever, toxic appearance, or if reliable follow-up cannot be ensured.

So, in most situations, choosing to observe first aligns with evidence-based practice: many cases resolve without antibiotics, and timely treatment can be started if the child does not improve or worsens.