The consensus, evidence-based 2004 guidelines recommend that children under 6 months of age with red hot ear infections should be treated with antibiotics for 10 days and pain relief for at least the first 24 hours, whether or not the diagnosis is certain. Remember, antibiotics do not help pain during the most painful first 24 hours, and help pain only minimally after that.

Kids 6 months to 2 years should receive 10 days of antibiotics and at least 24 hours of pain relief for a red hot ear if the diagnosis of an acute ear infection is certain (it must be an abrupt onset, with physical certainty of fluid in the ears, and clear evidence of an inflamed eardrum - all 3). If the diagnosis of an acute infection is uncertain in these kids, they can be treated with pain relief and observed without antibiotics, (we'll talk about what this means soon), unless they've had a fever of 102.2 or higher in the last 24 hours, or severe symptoms.

Once children have reached their second birthdays, pain relief and antibiotics are recommended if both the diagnosis of an acute infection is certain and the illness is severe with a fever of at least 102.2 or symptoms of severe illness. Otherwise, observation and pain relief can be the better course of action. Most kids without a high fever don't need antibiotics for ear infections.

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