How Are Ear Infections Treated?

Doctor Examining Girl's Ear, With Otoscope
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Ear infections, also called acute otitis media, often require medical intervention. The way your doctor chooses to treat an ear infection depends on a variety of factors including whether or not the germ responsible for the infection has been identified. If you have already had treatment that did not improve your symptoms, it is OK, as your doctor can also modify the approach used to treat you.

Some physicians treat all ear infections with an antibiotic, but recent concern about the overuse of antibiotics, which can lead to "superbugs", has prompted the American Academy of Pediatrics (AAP) to revise their guidelines.

The new guidelines encourage doctors to back off of the antibiotics in certain cases.

Should Antibiotics Be Used?

If you are concerned about the possibility of an ear infection, you should see your doctor. You should particularly seek medical attention if your temperature is greater than 100.4°F, or have ear drainage present. The doctor will use an otoscope to see the ear drum to determine if you have fluid in your ear (also known as otitis media with effusion) or if you have an ear infection.

If your child is older than six months and is otherwise healthy without a high fever, your doctor may choose to observe your child for 48 to 72 hours rather than prescribe an antibiotic initially. Children who do not qualify for observation include those who:

  • are less than 6 months of age
  • have an underlying medical illness, cleft palate, or immune disorders for example
  • have severe symptoms such as a fever over 102.2°F

If antibiotic therapy is required, studies have shown that amoxicillin is the antibiotic of choice. Make sure you follow the directions on the bottle exactly to avoid recurrence and the creation of resistant bacterial strains.

Azithromycin or cephalosporins like cefdinir or ceftriaxone are good alternatives for patients with penicillin allergies.

What If Antibiotics Don't Cure My Child's Ear Infection?

If antibiotics are used, amoxicillin will often be sufficient to treat a bacterial ear infection. However sometimes the ear infection will be caused by a bacteria resistant to penicillin antibiotics. If amoxicillin doesn't work, you doctor will likely try amoxicillin-clavulanate followed by either azithromycin or ceftriaxone. If the ear infection is caused by a virus, antibiotics will not help in treating the ear infection. In this case, the best thing to do is manage symptoms and wait for the body's immune system to fight the infection off.

Treating Symptoms of an Ear Infection

The most common and concerning symptoms associated with acute ear infections are pain and fever. In small children, some other signs that may indicate an ear infection include:

  • crying
  • pulling or tugging at the ears
  • waking up in the middle of the night (laying down increases the pressure in the auditory tube)

    Antibiotics alone will not help relieve these symptoms initially, as it generally takes a minimum of 24 hours before antibiotics will help with pain or fever. The primary method for treating pain associated with ear infections are acetaminophen or ibuprofen. For older children, a dosing chart is on the back of the bottle. For younger children and infants, the label often recommends consulting your physician. Ask your doctor to calculate a proper dose for your child according to their weight. Acetaminophen can be given every 4 hours while ibuprofen should be given every 6 to 8 hours.

    Over-the-counter analgesics like Tylenol and Motrin should cover a moderate amount of pain. However, if your child is still having severe pain, your doctor can prescribe a narcotic (like codeine) or ear drops with an anesthetic (like benzocaine).

    Sources:

    American Academy of Pediatrics.Diagnosis and Management of Acute Otitis Media. Accessed: October 28, 2013 from http://pediatrics.aappublications.org/content/131/3/e964.full?sid=9cdf466d-8e53-496b-9c5e-a2aa52b0a850#sec-68

    American Academy of Pediatrics. Questions & Answers on Acute Otitis Media. Accessed: March 5, 2009 from http://www.aap.org/advocacy/releases/aomqa.htm

    Center for Disease Control and Prevention. (2015). Ear Infection. Accessed on January 24, 2016 from http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/ear-infection.html

    National Institute on Deafness and Other Communication Disorders. Otitis Media (Ear Infection). Accessed: March 5, 2009 from http://www.aap.org/advocacy/releases/aomqa.htm

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