Ear Infections: Antibiotics Often Not Needed
Most Children With Middle Ear Infections Get Better on Their Own, Study Finds
The analysis found antibiotics to be âmodestlyâ more effective than just treating symptoms with pain medication. But use of antibiotics was also commonly associated with side effects like diarrhea and rash.
Researchers say the review, published in the Journal of the American Medical Association, shows the merit of a watch-and-wait approach to managing ear infections.
When Antibiotics Are Used
Antibiotics are typically only prescribed for AOM.
OME and COME occur after an infection has already occurred. Antibiotics cant treat fluid buildup if theres no active infection.
An antibiotic may be prescribed for an active ear infection once your doctor has examined your ear and has determined you exhibit signs and symptoms of AOM or swimmers ear.
Frequent or recurring ear infections should also be addressed with a doctor. Due to concerns with antibiotic resistance, recurring ear infections or COME shouldnt always be treated with antibiotics.
Depending on the severity of your ear infection, your doctor may hold off on prescribing antibiotics.
What Are The Advantages Of Ototopical Antibiotics
Administration of antibiotics directly in the ear has several advantages over systemic delivery including the following:
Topical antibiotic solutions contain vastly greater concentration of antibiotic than the medications administered orally, or even intravenously. The high antibiotic concentration, delivered directly at the site of the infection, is much more effective in killing the bacteria. It also reduces the possibility for development of antibiotic-resistant bacterial strains.
The lowest level of drug concentration that can prevent bacterial growth is known as minimum inhibitory concentration . Some drug-resistant bacteria have a high MIC, but ototopical antibiotics far exceed the MIC required for destroying even highly resistant bacteria.
Absence of systemic effects
The absence of systemic effects with topical administration eliminates the risk of systemic antibiotic side effects. The normal beneficial bacteria that live in the respiratory and gastrointestinal tracts are unaffected. Absence of systemic antibiotics also prevents the natural selection and proliferation of drug-resistant bacteria.
Alteration of microenvironment
Ototopical antibiotics are generally less expensive than comparable systemic medications.
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When Antibiotics Really Are Needed
According to the AAP guidelines, all babies under 6 months who develop an ear infection should be treated with antibiotics. Kids between 6 months and 2 years also should get antibiotics if their pediatrician is certain they have an ear infection. A child who has severe symptoms, such as extreme pain or a fever over 102.2 F, also should be treated with antibiotics even if the doctor isn’t 100 percent certain she has an ear infection.
Most children with certain chronic health issues also should be put on antibiotics for an ear infection. This includes kids with Down syndrome, immune system problems, cleft palate, or a cochlear implant. The same holds true for any child who’s had an ear infection in the previous 30 days or has chronic fluid in her ears.
Ear Infection Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
When To See Your Doctor
See your doctor if your child:
- Is six months of age or younger
- Has a high fever or bad earache
- Has an ear discharge that lasts more than 24 hours
- Continues to have fever or bad earache two days after they start treatment
- Still seems to have trouble hearing after six to eight weeks
- Seems to be getting worse or you are worried at any time.
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What Causes Middle Ear Infections
Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube to become swollen or blocked.
This mean mucus can’t drain away properly, making it easier for an infection to spread into the middle ear.
An enlarged adenoid can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.
Younger children are particularly vulnerable to middle ear infections as:
- the Eustachian tube is smaller in children than in adults
- a child’s adenoids are relatively much larger than an adults
Certain conditions can also increase the risk of middle ear infections, including:
- having a cleft palate a type of birth defect where a child has a split in the roof of their mouth
- having Down’s syndrome a genetic condition that typically causes some level of learning disability and a characteristic range of physical features
What Are Resistant Bacteria
Each time you take an antibiotic, bacteria are killed. Sometimes, bacteria causing infections are already resistant to prescribed antibiotics. Bacteria may also become resistant during treatment of an infection. Resistant bacteria do not respond to the antibiotics and continue to cause infection. A common misconception is that a person’s body becomes resistant to specific medicines. However, it is the bacteria, not people, that become resistant to the medicines.
Each time you take or give your child an antibiotic unnecessarily or improperly, you increase the chance of developing medicine-resistant bacteria. Therefore, it is critically important to take antibiotics only when necessary. Because of these resistant bacteria, some diseases that used to be easy to treat are now becoming nearly impossible to treat.
Bacteria can develop resistance to certain medicines:
When Should I See A Doctor
A mild ear infection may go away on its own. But most cases of moderate to severe ear pain require a visit to your doctor. You should also see your doctor if youre experiencing ear discharge, fever, or chills.
Children with ear infections may constantly cry due to pain and discomfort. They might also tug or pull at the affected ear. See your doctor if symptoms dont improve within , or if they get worse.
Other signs that you should see a pediatrician include:
- fever of 102.2°F or higher
When Should I Call The Doctor About An Ear Infection
- You or your child develops a stiff neck.
- Your child acts sluggish, looks or acts very sick, or does not stop crying despite all efforts.
- Your childs walk is not steady he or she is physically very weak.
- You or your childs ear pain is severe.
- You or your child has a fever over 104° F .
- Your child is showing signs of weakness in their face .
- You see bloody or pus-filled fluid draining from the ear.
- The fever remains or comes back more than 48 hours after starting an antibiotic.
- Ear pain is not better after three days of taking an antibiotic.
- Ear pain is severe.
- You have any questions or concerns.
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What Is The Treatment For Ear Infections
Medications used to treat ear infections include:
- Pseudoephedrine to ease ear pressure
- Antibiotic ear drops for infections of the ear canal
- Polymyxin B
- Steroid ear drops for infections of the ear canal
- Oral antibiotics for infections of the middle ear , and severe infections of the outer ear
For mild cases of ear infection, doctors often recommend watching and waiting before starting use of antibiotics, as many cases will go away on their own. Consult your childs pediatrician before giving any over-the-counter medications to your child.
Home remedies to relieve symptoms include:
- Warm compresses applied to the area to help soothe pain
- Over-the-counter pain eardrops
When You Need Themand When You Dont
Many children get ear infections. The infections are usually in the middle ear behind the eardrum. They may be caused by bacteria or by a virus. Doctors often treat bacterial infections with antibiotics. Antibiotics are strong medicines that kill bacteria.
Infants and some babies and children do need antibiotics.
But using antibiotics too often can be harmful. Heres why:
In most cases, antibiotics are not needed.
- They do not work for ear infections caused by viruses.
- They do not help the pain.
- Usually, viral infections and many bacterial infections go away on their own in two to three days, especially in children who are over two years old.
First, call the doctor and treat the pain.
If you suspect your child has an ear infection, you should call the doctors office and describe the symptoms. Usually, your doctor should ask you to wait a few days before bringing your child in.
The main sign of an ear infection is pain, especially on the first day. Or, a child may have a fever.
Start by giving your child an over-the-counter pain reliever, such as:
- acetaminophen .
- ibuprofen .
Antibiotics do not relieve pain in the first 24 hours. They only have a small effect on pain after that. So, pain relievers are an important treatment, and usually they are the only treatment needed.
When is treatment with antibiotics needed?If the infection is very painful and lasts more than a few days, chances are it is a bacterial infection.
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What Are Other Causes Of Ear Pain
Other causes of ear pain include:
- A sore throat.
- Teeth coming in in a baby.
- An infection of the lining of the ear canal. This is also called swimmers ear.
- Pressure build up in the middle ear caused by allergies and colds.
Last reviewed by a Cleveland Clinic medical professional on 04/16/2020.
Anatomy Of An Ear Infection
The ear is divided into the outer ear, middle ear, and inner ear. Infection can occur in any of these areas, but bacterial infections of the inner ear are extremely rare.
Bacteria, viruses, and fungi can cause infections in the ear. Infections can be brought on by an illness, such as a cold or allergies.
Ear infections generally occur when bacteria, viruses, or fungi gain entry into one of the three areas of the ear and cause infection.
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When Taking An Antibiotic
It is important to take antibiotics in the correct way. If you do not, this may reduce how well they work. For example, some antibiotics need to be taken with food and others should be taken on an empty stomach. If you do not take your antibiotics in the right way it will affect how much of them get into your body and therefore they may not work as well. So, follow the instructions as given by your doctor and on the leaflet that comes with the antibiotic you are prescribed.
Always take the entire course of antibiotics as directed by your doctor. Even though you may feel better before your medicine is entirely gone, follow through and take the entire course. This is important for your healing. If an antibiotic is stopped in mid-course, germs may be partially treated and not completely killed. Bacteria may then become resistant to that antibiotic.
Overuse of antibiotics has led to some bacteria changing their form or structure and becoming resistant to some antibiotics, which may then not work when really needed. For example, meticillin-resistant Staphylococcus aureus is a bacterium that has become resistant to many different antibiotics and is difficult to treat. Other bacteria produce chemicals called enzymes such as extended-spectrum beta-lactamases which allow them to be resistant to certain antibiotics.
Diagnosis Of Ear Infections
Your physician will look into your ear with an otoscope, a medical instrument with a light on one end designed to get a better view inside the ear. Your doctor will look for the visual signs of ear infection, such as redness and inflammation.
To check for fluid buildup, a pneumatic otoscope, which blows air at the eardrum, will be used. If there is excessive fluid behind the eardrum, it will not move as it should when the air hits it.
In some cases, hearing tests may also be performed to assess any damage to the ear from the infection.
Different types of ear infections present with different symptoms, which can include:
- Inner ear infections: Hearing loss, ringing in the ears , dizziness, loss of balance, nausea and vomiting, and ear pain
- Middle ear infections: Fluid in the ear, ear pain, fever, a feeling of general illness, pressure in the ears, and hearing loss
- Outer ear infections: Inflammation of the ear canal, itching in the ear, ear pain, swelling of the ear canal, redness, and fluid draining from the ear
Ear Infection Doctor Discussion Guide
Children with ear infections, especially toddlers or infants, may not be able to describe their symptoms, but an ear infection will often present with the following signs:
- Tugging or pulling at their ears
- Fussing or crying
- Being clumsy and having balance issues
- Trouble hearing or responding to quiet noises
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What Are The Types Of Ototopical Antibiotics
Ototopical antibiotics are available in three forms:
Powders are not approved by FDA, but regionally compounded powders have been in use for years. Powders have the advantage of adhering to and remaining for a long time in moist surfaces. Powders are prepared with several components.
Two preparations of powders used are:
- Gold dust: comprised of chloramphenicol, sulfanilamide and hydrocortisone
- Mastoid powder: comprised of ciprofloxacin, clotrimazole, dexamethasone and boric acid
Creams and ointments
Creams and antibiotics are applied only for bacterial and fungal infections in the external ear and auditory canal, usually with a single dose. Following are some of the antibiotic ointments and creams used for external ear infections:
When Is Treatment With Antibiotics Necessary For An Ear Infection
If your child is in a lot of pain, and the symptoms last more than a few days, your pediatrician will likely recommend a round of antibiotics. According to the AAFP, here are some of the circumstances where antibiotics are likely to be prescribed for an ear infection:
- Infants six months or younger.
- Babies ages six months to two years, who have moderate to severe ear pain.
- Children 2 years or older who have a fever of 102.2 or higher.
- Children with another condition that could make an infection harder to heal, including cleft palate, Down syndrome, immune disorders and cochlear implants.
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When Are Antibiotics Needed
This complicated question, which should be answered by your healthcare provider, depends on the specific diagnosis. For example, there are several types of ear infectionsmost need antibiotics, but some do not. Most cases of sore throat are caused by viruses. One kind, strep throat, diagnosed by a lab test, needs antibiotics.
Common viral infections, like coughs or a cold, can sometimes become complicated and a bacterial infection can develop. However, treating viral infections with antibiotics in order to prevent bacterial infections is not recommended because of the risk of causing bacterial resistance:
Remember that antibiotics do not work against viral colds and the flu, and that unnecessary antibiotics can be harmful.
Talk with your healthcare provider about antibiotics and find out about the differences between viruses and bacteria, and when antibiotics should and should not be used.
If your child receives an antibiotic, be sure to give it exactly as prescribed to decrease the development of resistant bacteria. Have your child finish the entire prescription. Don’t stop when the symptoms of infection go away.
Never save the left over antibiotics to use “just in case.” This practice can also lead to bacterial resistance.
Do not share your antibiotics with someone else or take an antibiotic that was prescribed for someone else.
Antibiotic resistance is a problem in both children and adults.
About Middle Ear Infections
Otitis media is an infection of the middle ear that causes inflammation and a build-up of fluid behind the eardrum.
Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.
It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old.
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Antibiotics For Wound Infection
Jennifer is a contributing health writer who has been researching and writing health content with PlushCare for 3 years. She is passionate about bringing accessible healthcare and mental health services to people everywhere.
Dr. Katalin Karolyi
Dr. Katalin Karolyi
Katalin Karolyi, M.D. earned her medical degree at the University of Debrecen. After completing her residency program in pathology at the Kenezy Hospital, she obtained a postdoctoral position at Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida.
Types Of Ear Infections
The most common type of ear infection is called acute otitis media .
AOM is more common in children because they have smaller eustachian tubes. Located between the middle ear and upper throat, these tubes are responsible for fluid drainage.
If this fluid doesnt drain, a buildup and infection may occur. Fluid trapped in the middle ear behind your eardrum may also cause:
Other common infections
Other common types of ear infections include:
- Otitis media with effusion . The infection has cleared up, but fluid may still be stuck in the middle ear.
- Chronic otitis media with effusion . Fluid continues to build up on a recurring basis despite the lack of infection. This chronic condition can lead to serious side effects, such as hearing loss .
- Swimmers ear : occurs in the outer ear when water becomes trapped and promotes bacterial growth in the ear canal.
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When To See A Doctor
Ear infections can go away on their own in many cases, so a minor earache may not be a worry.
A doctor should typically be seen if symptoms have not improved within 3 days. If new symptoms occur, such as a fever or loss of balance, a doctor should be seen immediately.
Any sign of discharge coming from the ear would also require a visit to the doctor.