NHS treatment for ear infection (acute otitis media)

Children 1-17 with earache and signs of middle-ear infection can be assessed by our pharmacist using an otoscope. Same-day in-person consultation — this pathway needs a physical examination.

This pathway needs a physical otoscope examination of the eardrum, so you must attend the pharmacy in person. You can start the assessment online to save time on arrival, but the consultation itself is in-person only.

What is acute otitis media?

Acute otitis media (AOM) is infection of the middle ear — the air-filled space behind the eardrum. It's one of the most common reasons parents seek same-day care for young children.

Most cases follow a cold and clear on their own within 3-7 days. A minority benefit from antibiotics — particularly children with high fever, both ears affected, or fluid leaking from the ear.

Typical symptoms in children

Earache (older children point to or pull at their ear)
Crying, irritability, poor sleep (younger children)
Fever
Reduced hearing on the affected side
Sometimes nausea or vomiting
Fluid or pus leaking from the ear — this means the eardrum has burst. Pain often eases when this happens, but the infection still needs assessment, and antibiotics are usually offered.

Who can use this service?

Children aged 1-17
Symptoms consistent with acute otitis media
Able to attend in person for the otoscope examination
Not systemically very unwell
Not for children with frequently recurring ear infections (3 or more in the last 6 months, or 4 or more in the last year) — they need GP/ENT review rather than this pathway

Children under 1 should be assessed by a GP or NHS 111 — they need different decision-making, and serious infection can present more subtly.

What treatment can be supplied?

The NHS Pharmacy First otitis media pathway follows NICE guidance and offers, where clinically appropriate under the PGD:

Pain relief advice — paracetamol and/or ibuprofen at the right dose for the child's age and weight. This is the most important treatment for most children.
Phenazone with lidocaine ear drops (a topical pain reliever) — for children aged 1+ where the eardrum is intact
Oral amoxicillin — first-line antibiotic, considered when the pharmacist's examination shows the eardrum has perforated with discharge, or for younger children (under 2) with infection in both ears and severe symptoms lasting at least 3 days, or where the child is more systemically unwell. Most other children do better with pain relief alone or with phenazone/lidocaine ear drops.
Oral clarithromycin — alternative for children with penicillin allergy. Erythromycin may be used instead in specific situations (for example pregnant 16-17-year-olds with penicillin allergy).

Most children with AOM get better with pain relief alone. The pharmacist will explain the reasoning and what to watch for.

Antibiotics are not harmless — they can cause diarrhoea, rash and yeast infections, and using them when they aren't needed makes them less effective for everyone in the future. The pharmacist will only offer antibiotics when the examination shows they're likely to help. Medicines under this pathway are supplied under NHS England Pharmacy First Patient Group Directions 7b (amoxicillin), 7c (clarithromycin), 7d (erythromycin) and 7e (phenazone with lidocaine), version 1.1 valid from 1 October 2025.

How it works — online start, in-person finish

This pathway is the one exception to fully-online Pharmacy First — the pharmacist needs to examine the eardrum with an otoscope, which can't be done over phone or video.

Start the online assessment via the Digital Gateway link above — captures your child's symptoms, when they started, fever, any previous ear infections. About 5 minutes.
Pharmacist reviews your record and phones you back to book a same-day in-person slot, usually within an hour of your submission during opening hours.
Bring your child in at the booked time. Pharmacist examines the eardrum with the otoscope in our private consultation room.
Clinical decision — pain relief alone for most children, antibiotics (amoxicillin first-line) where clinically appropriate, or referral if more serious.
Medicine supplied immediately on-site — no waiting for delivery for this pathway.
GP notified automatically via NHS GP Connect.

Why not fully online? The eardrum can't be assessed via phone or video — we need the otoscope to see whether it's red, bulging, perforated, or normal. Starting online still saves time on arrival because your history is already captured.

Go to A&E or call 999 if your child has: a high temperature with severe drowsiness or unresponsiveness; a stiff neck or sensitivity to light; non-blanching rash (doesn't fade when you press a glass against it); severe pain, redness or swelling of the bony area just behind the ear (the mastoid); sudden loss of hearing with dizziness or vertigo; drooping of one side of the face; signs of dehydration or unable to keep fluids down. These signal possible serious complications (mastoiditis, meningitis, sepsis) and need urgent hospital care.

Start the assessment online before you come in

Open our NHS-assured Digital Gateway on your phone, answer the questions for your child, and we'll have the record ready. This pathway needs in-person otoscope examination — please come into the pharmacy after starting.

Start online assessment → Or call 0113 244 1551

Frequently asked questions

Will my child get antibiotics?: Often no — and that's a good thing. Whether antibiotics are appropriate is the pharmacist's clinical decision under the NHS Pharmacy First Patient Group Direction, based on the examination — it's not something parents can request as a default. Most ear infections clear on their own with pain relief.
Can I bring a child under 1?: Not under this pathway. Babies under 1 with ear pain or fever should be assessed by a GP or NHS 111 — they need different decision-making.
How long does an ear infection usually last?: Pain usually peaks in the first 2-3 days and improves over 3-7 days. If it's not improving by day 3 or is getting worse, come back.
Can I do an online consultation instead?: No — this is the only Pharmacy First pathway that can't be done online. The eardrum has to be examined with an otoscope. The other six pathways (sore throat, sinusitis, shingles, impetigo, infected insect bite, UTI) can be done with reduced or no in-person time.
What if my child has glue ear or grommets?: Tell the pharmacist. Children with grommets sometimes get different presentations of ear infection. Glue ear is different from acute infection. The pharmacist will assess carefully.
Is it free?: Yes — consultation and any medicine supplied through Pharmacy First are free.

About this service at Hyde Park Pharmacy

Hyde Park Pharmacy is a community pharmacy in central Leeds (premises 9011727, regulated by the General Pharmaceutical Council). Our superintendent pharmacist is Shoyab Umarji (GPhC #2065619, Independent Prescriber). The otitis media pathway follows v1.1 NHS England Pharmacy First service spec (October 2025).

For the full list of Pharmacy First conditions, see our main Pharmacy First page. For a step-by-step explanation of the post-submission flow, see what happens next.