Antibiotics for Ear Infections: The Best Treatment Options

Ear infections are incredibly common in children, and they can also affect adults. Oftentimes ear infections go away in a few days without any treatment. When an ear infection is severe or doesn’t resolve on its own, antibiotics may be a necessary and effective treatment. 

In this article, I’ll describe the different types of ear infections that affect children and adults. Then I’ll discuss the antibiotics used to treat ear infections and their possible side effects.

Finally, I’ll explain other treatment options, how best to prevent ear infections, and when you should speak with your doctor or pediatrician.

What Causes Ear Infections?

The ear is organized into three structures, the outer, middle, and inner ear. The outer ear contains the outer structure, the auditory canal and the tympanic membrane (ear drum).

The inner ear is an air-filled space that contains three small bones responsible for transferring vibrations from the eardrum to the inner ear. The inner ear is within the temporal bone and contains membranes and a solution which is responsible for sound transmission. 

There are three types of ear infections:

• Acute otitis media: an infection of the middle ear
• Otitis media with effusion: an infection of the middle ear when fluid builds up causing an infection
• Swimmer’s ear: infection of the outer ear canal

Bacteria or viruses cause ear infections. The most common bacteria for ear infections include streptococcus pneumoniae and haemophilus influenzae. Viruses that cause the common cold can cause ear infections. 

Symptoms include:

• Ear pain
• Fever
• Irritability or fussiness
• Trouble sleeping
• Rubbing or tugging at the ear

Antibiotics for Ear Infections

A medical provider can diagnose an ear infection by examining the person with the earache and asking questions about symptoms. Typically, the body can fight an ear infection without medical treatment and sometimes antibiotics are not needed. 

However, severe middle ear infections or infections lasting longer than two or three days need treatment with antibiotics in a timely fashion. 

The best antibiotics for ear infections include:

Antibiotic ear drops

Antibiotic ear drops (also called ototopical antibiotics) are the go-to treatment for recurrent bacterial ear infections. Since they are topical, the medication is delivered directly to the infected site with fewer side effects.

Ototopical antibiotics include:

• Cortisporin is a prescription otic suspension (liquid) used to treat bacterial ear infections and decrease inflammation. The most common side effect is stinging or burning when dropped into the ear.

• Ciprodex is a prescription otic suspension for bacterial middle or outer ear infections. It also helps reduce inflammation. It is usually taken twice daily for seven day. The most common side effects include itching, pain, or stinging in the ear.

• Ofloxacin is a prescription otic solution used to treat bacterial infections in the ears. It is safe to use when the ear drum has burst from the infection. Common side effects include pain or irritation where inserted, a bitter taste in the mouth, itching.

• Xtoro is a prescription otic suspension for treating swimmer’s ear. Common side effects include itching, pain, and skin irritation.

• Cetralix is a prescription otic solution for treating swimmer’s ear. It is also used to treat inner ear infections for kids undergoing ear tube surgery. Common side effects include itching, pain, sore throat, and stuffy nose. 

How to administer antibacterial ear drops

Antibiotic ear drops are for the ears only and should never be put into the eyes. Always take the entire prescribed amount even if your symptoms improve as it prevents a recurrence of the infection. 

Follow these steps to correctly administer ear drops:

• Warm the bottle in your hand for two minutes, inserting cold ear drops can cause dizziness
• Wash your hands
• Have the person with the ear infection lie on their side with the problem ear up
• For children three years and older, gently pull the outer ear outward and upward in the direction toward the top of their head
• For children younger than three years, gently pull the outer eat outward and downward in the direction toward their feet
• Without allowing the dropper to touch the ear, carefully put the drops in the ear
• Remain laying on their side for two minutes or put a cotton plug in the ear

Oral antibiotics

Some examples of oral antibiotics used to treat ear infections are: 

• Amoxil (amoxicillin) a penicillin antibiotic used to treat ear infections. Common side effects include nausea, vomiting, rash.

• Augmentin (amoxicillin/Clavulanic acid) is an oral liquid antibiotic used to treat ear infections. Common side effects include upset stomach and diarrhea.

• Zithromax (azithromycin) is an oral antibiotic used to treat ear infections. Common side effects include diarrhea, nausea, vomiting, headache.

• Keflex (cephalexin) is an oral antibiotic used to treat ear infections. Common side effects include changes in stool, stomach pain, nausea, and vomiting.

• Septra (sulfamethoxazole trimethoprim) is an oral antibiotic used to treat ear infections. Common side effects include nausea, vomiting, and skin rash.

Suspension vs Solution

Solutions and suspensions are both medications in liquid form. Solutions are when the active ingredients are completely dissolved in the liquid. 

Suspensions are when the drug particles are suspended throughout the liquid and are not dissolved completely. Some medications are more stable as suspensions rather than as solutions.

The main difference between the two types is their skin irritation level. Generally, solutions are more irritating and they sometimes contain alcohol which can be very irritating to inflamed skin. Suspensions are generally less irritating. 

What’s the Best Antibiotic for an Ear Infection?

Because each person and each ear infection is unique, there is no simple answer to this question.  One of the most commonly prescribed antibiotics for ear infections is amoxicillin. However, some types of bacteria are becoming resistant to it because of its frequent, and usually unnecessary, use. 

Ciprofloxacin is another commonly used antibiotic for fighting bacterial ear infections. The important thing is to follow the directions for whichever antibiotic your medical provider prescribes and to complete the entire treatment. Not completing the entire treatment increases the risk for recurrent infections and evolving bacteria that becomes resistant to antibiotics.

A couple days after starting the antibiotic, you may feel like the infection is gone. However, not completing the medication can allow the infection to return and for the bacteria to grow resistant to that antibiotic. 

Side Effects of Antibiotics

When taking antibiotics, be mindful of the following common side effects:

• Nausea and vomiting
• Diarrhea
• Indigestion, stomach pain, or bloating
• Yeast infections

Some people have allergic reactions to antibiotics.

If you notice any of the following, contact your doctor. Or, if you’re having a severe allergic reaction, call 911 or go to the emergency room:

• Rash
• Itching
• Wheezing or breathing problems
• Swelling of the throat
• Nausea or vomiting

Other Ear Infection Treatment Options

Most middle ear infections go away without any treatment within 2-3 days, while inner ear infections take a few weeks to resolve on their own.

No matter the type of ear infection, your healthcare provider may recommend treatments in addition to or in place of antibiotics to help clear the infection:

Over-the-counter (OTC) options 

For mild ear infections, OTC pain relievers may help soothe aches and fever until the infection clears.

Be sure to talk to your doctor about which OTC pain medication they recommend, particularly for children, who should never take aspirin.

Common OTC pain relievers for ear infections include acetaminophen (Tylenol) and ibuprofen (Advil). These should be taken with food to avoid side effects. 

If you or your child suffer from ear infections triggered by allergies, some OTC allergy medications may help reduce swelling in the mucous membranes and open up the eustachian tubes.

Talk to your doctor before trying any OTC allergy medication for an ear infection, as these will only help if the infection is caused by allergies.

Surgery 

For more severe or chronic ear infection cases, your doctor may recommend a surgical procedure called a myringotomy.

During this procedure, a surgeon creates a small hole in the eardrum to drain fluid from the ear.

Then they place a small tube (called a tympanostomy tube) in your ear to keep fluid from building up and to help relieve pressure in the middle ear. The tube usually falls out on its own within 4-18 months.

Preventing an Ear Infection

It isn’t always possible to prevent ear infections, especially those caused by bacterial or viral infections.

However, there are some things you can do to help prevent you or your child from getting ear infections:

• Wash hands well and often: This will help prevent the spread of germs, some of which can cause ear infections.
• Don’t smoke: And also try to reduce or eliminate your exposure to secondhand smoke.
• Get vaccinated: Staying up to date with vaccines (especially the flu vaccine) may help prevent ear infections.
• Manage your allergies: If allergies trigger your ear infections, talk with your doctor about the best measures to control your allergies.
• Hydrogen peroxide: This home prevention remedy may work particularly for swimmer’s ear by removing ear wax that can trap water and bacteria in your ear. Talk to your doctor or ENT before trying hydrogen peroxide, though.

When to See a Medical Provider

If you notice persistent ear infection symptoms that don’t resolve on their own, call a healthcare professional.

This is particularly important for adults, as a middle ear infection can be a sign of a more serious problem in this age group compared to children.

And if you experience chronic ear infections, talk to your primary care provider, an otolaryngologist (ear, nose, and throat specialist), or an otologist (ear subspecialist) to discuss treatment options.

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