What is the recommended treatment for a 3-year-old with ear tubes and an ear infection?

Treatment of Ear Infection in a 3-Year-Old with Ear Tubes

For a 3-year-old with ear tubes and visible ear drainage, use topical antibiotic ear drops (ciprofloxacin or ciprofloxacin-dexamethasone) twice daily for 7-10 days—oral antibiotics are unnecessary in most cases. 1

Treatment Algorithm Based on Presentation

If Visible Drainage or Discharge from Ear Canal:

Use topical antibiotic ear drops as first-line therapy:

• Ciprofloxacin or ciprofloxacin-dexamethasone ear drops are the preferred treatment 1, 2
• Administer drops twice daily for up to 10 days 1, 2
• After placing drops, "pump" the tragus (flap of skin in front of ear canal) several times to help drops enter the tube 1, 2
• Pull the ear gently backward and upward to straighten the ear canal for better drop delivery 2

Why topical therapy is superior:

• Clinical cure rates are 77-96% with topical drops versus only 30-67% with oral antibiotics 1, 2
• Delivers higher drug concentration directly at the infection site 1, 2
• Provides better coverage of likely pathogens including Pseudomonas aeruginosa and Staphylococcus aureus 2
• Avoids systemic side effects of oral antibiotics 2

Important care measures during treatment:

• Remove drainage buildup with cotton-tipped swab dipped in hydrogen peroxide or warm water 1, 2
• Prevent water entry by using cotton saturated with Vaseline to cover the ear canal opening during bathing 1, 2
• Do not allow swimming until drainage stops 1
• Do not use antibiotic ear drops for more than 10 days at a time to avoid yeast infections 1, 2

When oral antibiotics ARE needed:

• Only if the child appears very ill 1
• If another medical condition requires systemic antibiotics 1
• If infection does not resolve after using ear drops for 7 days 1, 2

If No Visible Drainage from Ear Canal:

First verify tube patency:

• Ask the primary doctor to confirm the tube is open and functioning 1
• If the tube is open, the infection should resolve without antibiotics or ear drops 1
• Use acetaminophen or ibuprofen for pain relief during the first few days 1

If tube is blocked:

• Treat as if the tube were not present (the blocked tube does no harm but provides no benefit) 1
• Consider high-dose amoxicillin (80-90 mg/kg/day in two divided doses) if antibiotics are deemed necessary 3, 4

When to Call the Otolaryngologist

Refer to ENT specialist if: 1, 2

• Primary doctor cannot visualize the tube in the ear 1
• Ear drainage continues for more than 7 days despite treatment 1, 2
• Drainage from ears occurs frequently 1, 2
• Child has hearing loss, continued ear infections, or persistent ear pain/discomfort 1, 2
• Excessive wax buildup in the ear canal 1, 2

Common Pitfalls to Avoid

Do not routinely prescribe oral antibiotics for ear infections with functioning tubes:

• The drainage indicates the tube is working properly to drain infection from the middle ear 1
• Most children do not have pain or fever when the tube is functioning 1
• Topical therapy alone is more effective than systemic antibiotics 1, 2

Do not worry about the appearance of drainage:

• Drainage can be clear, cloudy, or even bloody—this poses no danger to hearing 1
• The presence of drainage is actually a positive sign that the tube is functioning 1