Ear Infections - Medications

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In cases where complications are suspected, a consultation with an ear, nose, and throat specialist (called an otolaryngologist) should be strongly considered. This specialist may perform a tympanocentesis or myringotomy, procedures in which fluid is drawn from the ear and examined for specific organisms. But, this is reserved for severe cases.

Specific Antibiotics Used for Acute Otitis Media (AOM)

The selection of an antibiotic is determined in part by the severity of the child's condition as well as a history of response/non-response to antibiotic therapy. Treatment decisions take into account whether the child's condition is severe or non-severe.

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Amoxicillin is generally recommended for first-line treatment of AOM. The combination drug amoxicillin-clavunate is prescribed for patients who have severe pain or a fever higher than 102.2 degrees (39 degrees Celsius). Other drug classes may be prescribed if a child is allergic to penicillins or does not respond to the initial therapy.

The following treatment guidelines provide general recommendations based on the severity of a child's AOM.

First-line treatment for non-severe AOM:

• Amoxicillin 80-90 mg/kg per day orally. Amoxicillin is a penicillin antibiotic.

If the patient has an allergy or a history of non-response to penicillin drugs, one of the following antibiotics may be prescribed:

• Azithromycin or clarithromycin. These drugs are in the macrolide class and are administered orally.
• Cefdinir, cefuroxime, or cefpodoxime. These drugs are classified as cephalosporins and are administered orally. They may cause reactions in penicillin-allergic patients.

If the patient does not respond to amoxicillin or alternative antibiotic drugs after 48 to 72 hours, one of the following drugs may be prescribed:

• Amoxicillin-clavulanate, clindamycin, or ceftriaxone. Ceftriaxone is injected intramuscularly. The other two drugs are administered orally. Each of these drugs is a different type of antibiotic. Amoxicillin-clavulanate (Augmentin) is classified as a penicillin; ceftriaxone (Rocephin) is a cephalosporin; clindamycin (Cleocin) is a lincosamide.