What is the treatment for an ear infection?

Treatment of Ear Infections

For ear infections, the first-line treatment is amoxicillin for acute otitis media in children without ear tubes, while antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) are the preferred treatment for infections in children with ear tubes. 1, 2

Acute Otitis Media (AOM) Without Ear Tubes

Age-Based Treatment Approach

• For children under 2 years of age, antibiotic therapy is recommended immediately 1
• For children over 2 years of age, watchful waiting is reasonable unless there are marked symptoms (high fever, intense earache) 1, 3
• If watchful waiting is chosen, reassessment should occur after 48-72 hours of symptomatic therapy 1

First-Line Treatment

• Amoxicillin is the first-line antibiotic for uncomplicated AOM 2, 4, 3
• Typical treatment duration is 8-10 days for children under 2 years and 5 days for older children 1

Second-Line Treatment (for treatment failures or beta-lactamase producing organisms)

• Amoxicillin-clavulanate 1
• Cefuroxime-axetil or cefpodoxime-proxetil 1
• For penicillin allergies: macrolides, erythromycin-sulfisoxazole, or trimethoprim-sulfamethoxazole 1, 4

Ear Infections in Children with Tympanostomy Tubes

With Visible Drainage

• Topical antibiotic ear drops are the treatment of choice (ofloxacin or ciprofloxacin-dexamethasone) 1
• Apply drops in the ear canal twice daily for up to 10 days 1
• "Pump" the tragus (flap of skin in front of ear canal) after placing drops to help them enter the tube 1
• Oral antibiotics are unnecessary unless the child is very ill, has another reason to be on antibiotics, or the infection doesn't respond to ear drops 1
• Clinical cure rates with topical therapy (77-96%) are significantly higher than with systemic antibiotics (30-67%) 1

Without Visible Drainage

• If the tube is open/functioning, the infection should resolve without antibiotics 1
• If antibiotics are prescribed, consider waiting a few days before filling the prescription 1
• Use acetaminophen or ibuprofen for pain relief as needed 1
• If the tube is blocked, treat as if the tube was not there 1

Otitis Externa (Swimmer's Ear)

• Topical treatments alone are effective for uncomplicated acute otitis externa 5
• Topical antibiotic drops with steroids are significantly more effective than placebo 5
• Acetic acid is less effective than antibiotic/steroid drops when treatment extends beyond one week 5

Special Considerations

Otitis Media with Effusion (OME)

• Antibiotics are not indicated except in cases of AOM that continue beyond 3 months 1
• For prolonged course with hearing loss, refer to an ENT specialist 1

Recurrent Infections

• Children with recurrent infections may benefit from antibiotic prophylaxis 4
• Consider referral for tympanostomy tube insertion for children with:
  • Persistent OME for 3 months or longer 1
  • Documented language delay or significant medical complications 4

Common Pitfalls to Avoid

• Don't prescribe antibiotics for isolated redness of the tympanic membrane with normal landmarks 1
• Don't use antibiotic ear drops for more than 10 days at a time to avoid yeast infections of the ear canal 1
• Don't prescribe antibiotics without adequate visualization of the tympanic membrane; consider ENT referral if visualization is difficult 1
• For children with ear tubes, don't allow swimming until drainage stops 1