What is the treatment for an ear infection?

Treatment of Ear Infections

For ear infections with visible drainage (especially in children with tympanostomy tubes), topical antibiotic ear drops—specifically ciprofloxacin or ciprofloxacin-dexamethasone—are the best treatment, administered twice daily for up to 10 days, and oral antibiotics are unnecessary in most cases. 1, 2

Treatment Based on Type of Ear Infection

Acute Otitis Externa (Swimmer's Ear)

• Topical antibiotic drops are the primary treatment for acute otitis externa, targeting Pseudomonas aeruginosa and Staphylococcus aureus, the most common pathogens. 1
• Oral antibiotics have limited utility and should be avoided—approximately 20-40% of patients inappropriately receive oral antibiotics that are usually inactive against the causative organisms. 1
• Pain management with analgesics is essential as otalgia can be severe and disproportionate to visual findings. 1

Acute Otitis Media (Middle Ear Infection)

• High-dose amoxicillin (80-90 mg/kg/day) is the first-line antibiotic for acute otitis media in patients not allergic to penicillin. 3, 4, 5
• The most common bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. 1, 4
• Watchful waiting without immediate antibiotics is appropriate for children 6 months or older with uncomplicated unilateral acute otitis media and mild symptoms. 4, 5
• If symptoms persist after 48-72 hours of antibiotic therapy, switch to a second-line agent such as amoxicillin-clavulanate to cover β-lactamase-producing organisms. 4, 5

Ear Infections in Children with Tympanostomy Tubes

• Antibiotic ear drops alone (ofloxacin or ciprofloxacin-dexamethasone) are superior to oral antibiotics, with clinical cure rates of 77-96% versus 30-67% for systemic therapy. 1, 2
• Apply drops twice daily for up to 10 days, and "pump" the tragus after application to help drops enter the tube. 1, 2
• Oral antibiotics are unnecessary unless the child is very ill, has another indication for systemic antibiotics, or the infection doesn't resolve with topical therapy. 1

Application Technique for Ear Drops

• Place drops in the ear canal twice daily. 1, 2
• Pull the ear gently backward and upward in toddlers to straighten the ear canal for better drop delivery. 2
• "Pump" the tragus (flap of skin in front of the ear canal) several times after placing drops to facilitate entry. 1, 2

Essential Care Measures During Treatment

• Remove drainage from the ear canal opening using a cotton-tipped swab dipped in hydrogen peroxide or warm water. 1, 2
• Prevent water entry during bathing by using cotton saturated with Vaseline to cover the ear canal opening; no swimming until drainage stops. 1, 2
• Limit antibiotic ear drop use to 10 days maximum to avoid yeast infections of the ear canal. 1, 2

When to Escalate or Refer Care

• Refer to an otolaryngologist if:
  • Ear drainage continues for more than 7 days despite treatment 1, 2
  • Drainage from the ears occurs frequently 1, 2
  • The child has hearing loss, continued ear infections, or persistent ear pain 1, 2
  • Excessive wax build-up obstructs visualization or treatment 1, 2

Critical Pitfalls to Avoid

• Do not prescribe oral antibiotics for otitis externa—they are ineffective, promote resistance, and have systemic side effects without addressing the local infection. 1
• Do not use neomycin-containing drops in patients with known allergy to this agent. 1
• Do not continue antibiotic ear drops beyond 10 days as this increases risk of fungal superinfection. 1, 2
• Do not assume all ear infections require antibiotics—approximately one-third of acute otitis media cases resolve without antibacterial treatment. 1