I have acute otitis media for 4 days and after two 1‑gram doses of Augmentin (amoxicillin‑clavulanate) I feel better but still have a sensation of ear fullness; does this indicate treatment failure?

Ear Fullness After 4 Days Does Not Indicate Treatment Failure

Your persistent ear fullness after 2 doses of Augmentin does not indicate treatment failure, as you are feeling better overall and have not yet reached the 48-72 hour window required to assess antibiotic response. 1

Understanding Treatment Response Timeline

• Clinical improvement in acute otitis media should be evident within 48 to 72 hours of starting antibiotics—you have only taken 2 doses over approximately 1-2 days, which is insufficient time to declare treatment failure 1
• During the first 24 hours after diagnosis, symptoms may actually worsen slightly before beginning to improve in the subsequent 24 hours 1
• The key indicators of treatment success include: declining fever (if present), reduced irritability, and improved sleeping/drinking patterns—not necessarily complete resolution of ear fullness 1

Why Ear Fullness Persists

• Middle ear effusion (fluid) is extremely common and expected even after successful antibiotic treatment: 60-70% of patients have persistent middle ear effusion 2 weeks after treatment, 40% at 1 month, and 10-25% at 3 months 1
• The presence of middle ear effusion without acute symptoms is defined as otitis media with effusion (OME), which is a normal part of recovery and does not require antibiotic change 1
• Some patients with AOM have combined bacterial and viral infections, which can explain persistent mild symptoms despite appropriate antibiotic therapy 1

When to Consider Treatment Failure

You should only consider treatment failure if:

• You have persistent severe symptoms (not just ear fullness) after 48-72 hours of therapy 1
• Your otologic findings remain unimproved (worsening ear pain, fever, or ear drum appearance) 1
• You develop new or worsening symptoms rather than gradual improvement 1

What You Should Do Now

• Continue your current Augmentin regimen as prescribed and reassess at 48-72 hours from when you started treatment 1
• Monitor for improvement in your primary symptoms (pain, fever if present, overall feeling of illness) rather than focusing solely on ear fullness 1
• If you have no improvement or worsening by 48-72 hours, contact your physician to consider switching to intramuscular ceftriaxone (50 mg/kg) 1

Important Clinical Caveat

• A change in antibiotic may not be required in patients with mild persistent symptoms like isolated ear fullness, especially when other symptoms are improving 1
• Middle ear fluid from patients with persistent symptoms is sterile (no bacteria present) in 42-49% of cases, meaning the infection has cleared but fluid remains 1
• The sensation of ear fullness can persist for weeks after successful bacterial eradication and does not alone warrant antibiotic escalation 1