Treatment for Ear Infections
For ear infections (otitis media), high-dose amoxicillin (80-90 mg/kg/day) is the first-line treatment for children with acute otitis media, while topical antibiotic eardrops (ofloxacin or ciprofloxacin-dexamethasone) are preferred for infections in children with tympanostomy tubes. 1
Types of Ear Infections and Diagnosis
Acute Otitis Media (AOM)
- Diagnosed by:
- Acute onset of symptoms
- Presence of middle ear effusion
- Physical evidence of middle ear inflammation
- Symptoms like pain, irritability, or fever 2
- Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2
Otitis Media with Effusion (OME)
- Defined as middle ear effusion without acute symptoms
- Distinguished from AOM by:
- Absence of acute symptoms
- No distinct erythema of the tympanic membrane
- No bulging of the tympanic membrane 1
Treatment Algorithm for Ear Infections
1. Pain Management (First Priority)
- Assess pain in all children with AOM
- Options:
- Acetaminophen or ibuprofen for systemic relief
- Topical analgesics for faster relief (within 10-30 minutes) 1
2. Treatment for Acute Otitis Media
For Children Without Penicillin Allergy:
First-line: High-dose amoxicillin (80-90 mg/kg/day)
- 10-day course for children under 2 years and those with severe symptoms
- 7-day course for children 2-5 years with mild/moderate symptoms
- 10-day course for children ≥6 years with mild/moderate symptoms 1
Second-line (if first-line fails after 48-72 hours):
For Children With Non-Type I Penicillin Allergy:
- Cefdinir (14 mg/kg/day in 1-2 doses)
- Cefuroxime (30 mg/kg/day in 2 divided doses)
- Cefpodoxime (10 mg/kg/day in 2 divided doses) 1
For Children With Type I/Severe Penicillin Allergy:
- Clindamycin (30-40 mg/kg/day in 3 divided doses)
- Ceftriaxone (50 mg/kg IM or IV daily for 3 days) if not allergic to cephalosporins 1
For Adults:
- Amoxicillin is indicated for upper respiratory tract infections of the ear due to susceptible strains of Streptococcus species, S. pneumoniae, Staphylococcus spp., or H. influenzae 4
3. Treatment for Tympanostomy Tube-Related Infections
Preferred treatment: Topical antibiotic eardrops (ofloxacin or ciprofloxacin-dexamethasone) 5, 1
- Place drops in ear canal twice daily for up to 10 days
- "Pump" the tragus after placing drops to help them enter the ear tube
- Clean ear canal of debris before administering drops 1
Important: Oral antibiotics are unnecessary for most ear infections with tubes unless:
- Child is very ill
- Child has another reason to be on an antibiotic
- Infection doesn't resolve after using ear drops 5
Avoid: Aminoglycoside-containing eardrops due to risk of ototoxicity 1
4. Management of Otitis Media with Effusion (OME)
Recommended approach: Observation for uncomplicated OME following AOM treatment
- OME typically resolves spontaneously within 3 months
- Document laterality and duration of effusion 1
Not recommended: Antibiotics, decongestants, or nasal steroids (ineffective for clearing middle ear fluid) 2
Referral: Consider hearing evaluation if OME persists beyond 3 months 1
Special Considerations and Caveats
For Recurrent Infections
- Consider referral for tympanostomy tubes for children with:
- Documented language delay
- Significant medical complications
- Recurrent infections not responding to antibiotic therapy 6
Side Effect Management
- Monitor for diarrhea (more common with amoxicillin-clavulanate)
- Consider probiotic supplements taken 2 hours before or after antibiotics to reduce gastrointestinal side effects 1
Prevention Strategies
- Pneumococcal and influenza vaccination
- Reduce risk factors:
- Limit day care attendance when possible
- Eliminate tobacco smoke exposure 1
Follow-up
- Reexamine children with persistent symptoms despite 48-72 hours of antibiotic therapy
- For children with tympanostomy tubes, routine follow-up every 4-6 months is important 5
- Call the ear doctor if:
- Ear drainage continues for more than 7 days
- Drainage occurs frequently
- Child has hearing loss or continued ear pain/discomfort 5