How Middle Ear Infections Are Treated

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Proper treatment of an ear infection—also known as acute otitis media (AOM)— will greatly reduce the amount of ear pain that you are experiencing, as well as decrease your risk of other complications from an untreated infection. Options include over-the-counter therapies and prescription medications that your doctor can prescribe.

Explore these treatments for both pain and fighting the infection, as well as other treatments that you may want to understand.

Over-the-Counter Therapies

Pain is one of the most bothersome symptoms of an ear infection. Antibiotics will not help control ear pain (otalgia) for about 24 hours. Until antibiotics have had a chance to start working, you can use over-the-counter medications to help control the pain.

Ibuprofen or acetaminophen are the preferred options for children. Children under the age of 2 sometimes experience pain for three to seven days, so you will want to tailor the length of OTC pain control to how your child is reacting. You should ask your physician about over-the counter medications to ensure that you provide the right dose.

In general, here are standard doses for both ibuprofen and acetaminophen.

Ibuprofen

  • Children: 4 to 10 mg per kg every 6 to 8 hours as needed
  • Adults: 200 to 400 mg every 6 hours as needed

Acetaminophen

  • Children under 6 years old: 10 to 15 mg per kg every 4 to 6 hours as needed
  • Children 6 to 12 years old: 325 to 650 mg every 4 to 6 hours (not to exceed 1.625 grams per day)
  • Children greater than 12 years old: 325 to 650 mg every 4 to 6 hours (not to exceed 3.25 grams per day)

Dosing for children is usually listed in kg (kilograms). To calculate this, take your child's weight in pounds and multiply it by 2.2. You will then need to multiply your child's weight in kilograms by the recommended dose per kilogram.

If you're using liquid medication, the side of the box lists how many milligrams are in each milliliter. You can draw the appropriate amount in either a syringe or pour into a medicine cup.

Prescriptions

A diagnosis of an ear infection will require antibiotics. Amoxicillin has been a successful first-line choice for over 25 years. It covers S. pneumonia but not two of the other less common community-acquired ear infections: nontypable H. influenzae and M. Catarrhalis.

However, amoxicillin is usually successful for treating an ear infection and another choice may not be needed unless you have an allergy to penicillin. If you have an allergy to penicillin, your physician may prescribe you cefdinir, cefpodoxime, cefuroxime, or ceftriaxone.

Amoxicillin Dosage

Usual dosing is based on the severity of the ear infection. For adults:

  • Mild to moderate: 500 mg every 12 hours
  • Severe: 875 mg every 12 hours

For children:

  • 80-90 mg/kg per day in 2 divided doses

There are alternate dosing styles that your physician may want to use based on your symptoms or previous treatment history. A severe ear infection is usually classified as having severe hearing loss, high temperature, or severe ear pain.

Ear Drops

If over-the-counter pain medicine is not sufficient for pain control, your doctor may prescribe ear drops that contain a topical anesthetic. It is important to know that you should not use any ear drops with anesthetics if you have ear tubes in place.

Treatment Duration

Treatment will typically last for 5 to 7 days for the standard ear infection. However, your doctor may prescribe up to 10 days for a severe ear infection.

View Article Sources
  • Acute otitis media in adults. UpToDate website. http://www.uptodate.com (subscription required). Updated April 19, 2017.
  • Acute otitis media in children: Diagnosis. UpToDate website. http://www.uptodate.com (subscription required). Updated October 13, 2017.
  • Lieberthal, AS, Carroll, AE, Chonmaitree, T, Ganiats, TG, Hoberman, A ... Tunkel, DE. (2013). The Diagnosis and Management of Acute Otitis Media. Pediatrics 131(3), e964-e999.