Antibiotics will not reduce pain in the first 24 hours.
Antibiotics have side effects, such as vomiting, diarrhoea and skin rash. For every child who benefits (1 in 7), another will suffer from side effects.
Treating with antibiotics cuts down the risk of more serious spread of infection.
To cure one child with an antibiotic the doctor needs to treat seven. That is, six out of seven do not need or do not respond to an antibiotic. All seven have to be treated, as it is impossible to tell which child will respond at the outset.
Use of antibiotics reduces the risk of pain, after 2-7 days, by 40%.
In order to achieve this for one child, 17 children need to be given antibiotics at the outset. (As only 14% still have pain at this stage, anyway.)
Further attacks are just as likely to happen even after antibiotics.
Using an antibiotic makes it less likely that an an infection will develop in the other ear.
17 children need to be treated before one infection in the other ear is prevented.
There is no evidence that using an antibiotic makes a child less likely to be deaf a month or three months after an infection.
We are increasingly aware that unnecessary use of antibiotics can increase the risk of "superbugs" developing, which can resist the antibiotics when we need them for more serious infections.