Treatment of Middle Ear Infections
Antibiotics: If a physician confirms a middle ear infection, she will likely prescribe an antibiotic. The first antibiotic we prescribe, if there is no allergy to it, is amoxicillin. Due to widespread use of antibiotics, some ear infections will not respond to amoxicillin and will require a stronger antibiotic. This is more likely in younger children, children who have had past ear infections, and children who attend day care. The reason to try amoxicillin first is that, if it does work, you are “saving” the stronger antibiotics for later, if you need them. The more you use any antibiotic, the more likely it won’t work the next time. If it has been at least two months since your last antibiotic treatment, it is reasonable to try amoxicillin again. Just because it hasn’t worked in the past doesn’t mean it won’t work this time!
Pain and fever control: Treat pain and fever with ibuprofen (Motrin) or acetaminophen (Tylenol). If the fever or pain lasts longer than 72 hours after starting the antibiotic, call the office.
Numbing ear drops: There are numbing ear drops available by prescription that often help with the pain. The drops may sting initially, but will hopefully provide relief within minutes. Use 1-2 drops in the affected ear every 1-2 hours as needed. These drops can be safely used with antibiotics and Motrin or Tylenol. If you see blood or pus draining from your ear, do not use the drops.
Warm or cool washcloths may provide some relief.
Upright positioning: Keeping you in a more upright position may help alleviate pressure and make yourself more comfortable.
Observation without antibiotic treatment: Many ear infections are viral or will resolve on their own without antibiotics. Therefore, it is reasonable in certain cases to treat the pain of the infection and monitor the patient without administering antibiotics. An ear infection is more likely to clear on its own if the patient is older and has not had frequent ear infections. If the pain or symptoms last longer than three days, it is less likely that the infection will clear on it’s own.
You should be feeling better within 72 hours of treatment. If not, call the office. In some situations, your doctor may have you schedule an ear recheck. This is usually done 2-3 weeks after the completion of the entire course of antibiotics. This is especially important if you had repeated ear infections. An earache is not an emergency and can wait until morning, if the office is closed, without added risk of complications. It is not uncommon for a child to complain of ear pain and not have an infection. Therefore, it is not good medicine to provide antibiotics over the phone for ear pain.
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