What is the treatment for otitis media (ear infection)?

From the Guidelines

To treat an ear infection, start with pain management and consider a watchful waiting approach for 48-72 hours, as many ear infections resolve without antibiotics, and if symptoms persist or worsen, antibiotics such as amoxicillin may be prescribed. The treatment approach should prioritize pain management using over-the-counter medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours for adults 1. For mild infections, a watchful waiting approach for 48-72 hours may be appropriate as many ear infections resolve without antibiotics.

Key Considerations

• Apply a warm compress to the affected ear for 10-15 minutes several times daily to help reduce pain.
• If symptoms persist or worsen, see a healthcare provider who may prescribe antibiotics such as amoxicillin (typically 80 to 90 mg per kg per day) 1 or amoxicillin-clavulanate.
• For swimmer's ear (outer ear infection), antibiotic ear drops like ciprofloxacin-dexamethasone or ofloxacin are usually prescribed, typically 3-4 drops in the affected ear twice daily for 7-10 days 1.
• Keep the ear dry during treatment by avoiding swimming and using earplugs during showers.
• Ear infections occur when bacteria or viruses infect the middle ear (behind the eardrum) or the outer ear canal, causing inflammation, fluid buildup, and pain.
• Seek immediate medical attention if you experience severe pain, high fever, dizziness, or hearing loss.

Antibiotic Therapy

• Systemic antibiotic therapy is not recommended for first-line therapy of uncomplicated, acute TTO but is appropriate, with or without concurrent topical antibiotic therapy, when signs of severe infection exist or acute TTO persists, or worsens, despite topical antibiotic therapy 1.
• Topical antibiotic therapy avoids adverse events associated with systemic antibiotics and is the preferred treatment for acute TTO, with ofloxacin or ciprofloxacin-dexamethasone being approved for use with tympanostomy tubes 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Otitis Externa:The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. Acute Otitis Media in pediatric patients with tympanostomy tubes:The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (from 1 to 12 years old) with tympanostomy tubes is: Five drops (0.25 mL, 0. 75 mg ofloxacin) instilled into the affected ear twice daily for ten days. Chronic Suppurative Otitis Media with perforated tympanic membranes:The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.

The treatment for an ear infection with ofloxacin (otitis externa, acute otitis media with tympanostomy tubes, or chronic suppurative otitis media with perforated tympanic membranes) involves instilling drops into the affected ear.

• For otitis externa:
  • Pediatric patients (6 months to 13 years): 5 drops once daily for 7 days
  • Patients 13 years and older: 10 drops once daily for 7 days
• For acute otitis media with tympanostomy tubes (pediatric patients 1 to 12 years): 5 drops twice daily for 10 days
• For chronic suppurative otitis media with perforated tympanic membranes (patients 12 years and older): 10 drops twice daily for 14 days 2

From the Research

Treatment Options for Ear Infections

• Amoxicillin is a commonly prescribed antibiotic for the treatment of acute otitis media (AOM) in children, with or without clavulanate 3, 4, 5, 6.
• The dosage frequency of amoxicillin can be either twice or three times daily, with similar efficacy and safety profiles 3, 5, 6.
• High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is recommended for the treatment of AOM, despite increasing antimicrobial resistance 4.
• Alternative antibiotics such as cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone may be prescribed for persistent or recurrent AOM 4.
• Azithromycin is also an effective treatment option for AOM, with a 3-day dosing regimen showing similar efficacy to a 10-day course of co-amoxiclav 7.

Administration and Compliance

• Twice-daily dosing of amoxicillin may offer advantages for caregivers in terms of administration schedule and adherence 6.
• A lower number of daily doses is associated with higher adherence to treatment 6.
• The taste of suspension, dosing frequency, and duration of therapy are key factors in enhancing compliance 4.

Efficacy and Safety

• Amoxicillin administered twice daily has similar efficacy to a three-dose daily regimen in the treatment of AOM in children 3, 5, 6.
• Azithromycin given over 3 days is as effective as co-amoxiclav for treatment of AOM, with fewer adverse events and better tolerance 7.
• The risk of adverse events, such as diarrhea, is generally low and similar between different treatment regimens 5, 7.