Is it appropriate to wait 2 days to attempt removal of a foreign object (a small piece of paper) from a child's ear, as advised by an urgent care doctor, when the child is asymptomatic (no pain, discharge, or fever) and has been prescribed amoxicillin (amoxicillin) as a precautionary measure?

Foreign Body in Child's Ear: Appropriateness of Delayed Removal with Prophylactic Antibiotics

The urgent care physician's approach is questionable and not supported by standard guidelines—prophylactic amoxicillin is not indicated for an asymptomatic ear foreign body, and a 2-day delay for removal is reasonable only if the child truly cannot cooperate, but antibiotics should not be routinely prescribed in this scenario.

Why Prophylactic Antibiotics Are Not Indicated

The guidelines for ear infections do not support prophylactic antibiotic use for foreign bodies in the ear canal without signs of infection. 1, 2

• No infection present: Your son has no pain, discharge, or fever—these are the key signs that would indicate an ear infection requiring antibiotics 1, 3
• Amoxicillin is for acute otitis media (middle ear infection): The American Academy of Pediatrics recommends amoxicillin specifically when there is a diagnosed ear infection with symptoms like ear pain, fever, or bulging eardrum 1, 2
• Foreign bodies alone don't require antibiotics: A piece of paper in the ear canal is not an infection and doesn't warrant preventive antibiotics unless there are signs of trauma, infection, or the object has been present long enough to cause inflammation 3

When Antibiotics ARE Appropriate for Ear Problems

To understand why this doesn't apply to your situation, here's when antibiotics are actually needed: 1, 2

• Acute otitis media with symptoms: Pain, fever, bulging eardrum 1
• Visible ear drainage: Topical antibiotic drops (ciprofloxacin or ciprofloxacin-dexamethasone) are preferred over oral antibiotics 1, 4, 2
• Signs of infection: Cellulitis, severe pain, high fever, toxic appearance 1
• Otitis externa (swimmer's ear): Topical drops are first-line, not oral antibiotics 3, 4

The 2-Day Wait: Reasonable or Not?

The delay itself is acceptable if removal attempts would risk eardrum injury, but the antibiotic prescription is unnecessary. 1

• Cooperation is critical: Attempting removal on an uncooperative child can cause eardrum perforation or push the object deeper 1
• Paper is relatively benign: Unlike button batteries (which are emergencies) or sharp objects, paper is unlikely to cause immediate harm if left for 2 days 3
• Observation period is standard: The American Academy of Pediatrics supports observation periods of 48-72 hours for various ear conditions when immediate intervention isn't critical 1

What You Should Actually Do

Monitor for signs of infection and return in 2 days for removal, but you likely don't need to give the amoxicillin unless symptoms develop: 1, 3

1. Watch for warning signs that would require immediate attention:

   • New ear pain or worsening discomfort 3
   • Fever developing 1
   • Discharge from the ear canal 1, 4
   • Hearing loss or child complaining about hearing 3, 2
   • Behavioral changes suggesting pain 1

2. Keep the ear dry: Don't let water enter during bathing 1, 4

3. Return in 2 days as planned for removal attempt 1

4. Consider ENT referral if: The second removal attempt fails, or if you want a specialist to handle it from the start (which is reasonable given your concerns) 3, 2

Common Pitfalls to Avoid

• Don't try to remove it yourself at home: You risk pushing it deeper or injuring the ear canal or eardrum 1
• Don't give antibiotics "just in case": This contributes to antibiotic resistance and exposes your child to unnecessary side effects (diarrhea, rash, allergic reactions) 1, 2, 5
• Don't delay if symptoms develop: If pain, fever, or discharge appears, return immediately rather than waiting the full 2 days 1, 3

The Bottom Line on This Specific Recommendation

The urgent care doctor was appropriately cautious about not forcing removal and risking injury, but prescribing prophylactic amoxicillin for an asymptomatic foreign body is not evidence-based practice. 1, 2 You can safely hold the antibiotic unless symptoms develop, continue monitoring, and return for the scheduled removal attempt. If you're uncomfortable with this plan or want more definitive care, seeking an ENT consultation directly is a reasonable alternative. 3, 2