When to Use Amoxicillin for Ear Infections

Because antibiotics (e.g., Amoxicillin) are only helpful in treating bacterial infections, as opposed to viral, the American Academy of Pediatrics (AAP) issued guidelines in 2013 to help pediatricians and parents make smarter decisions about when antibiotics are necessary to treat ear infections.

Most children will get an ear infection at some point during their childhood. Ear infections are the most common reason a child will see a healthcare professional and five out of six children will have at least one ear infection by their third birthday.

This article takes you through diagnosis, the judicious use of antibiotics by healthcare providers, and the treatment process that will ease a child's ear infection pain.

Types of Bacterial Ear Infections

Different types of ear infections present with different symptoms. Bacteria or viruses may be the cause of each of these types:

• Inner ear infections (otitis internal): Hearing loss, ringing in the ears (tinnitus), dizziness, loss of balance, nausea and vomiting, and ear pain
• Middle ear infections (acute otitis media or AOM): Fluid in the ear, ear pain, fever, malaise, pressure in the ears, and hearing loss
• Outer ear infections (otitis externa): Also known as swimmer's ear, inflammation of the ear canal, itching in the ear, ear pain, swelling of the ear canal, redness, and fluid draining from the ear
  

Diagnosing a Bacterial Ear Infection

Many infections have a viral or allergic cause and it's not always easy to tell if an ear infection is bacterial. Healthcare providers use the AAP guidelines to help determine when antibiotics are appropriate.

A bacterial ear infection is diagnosed through a physical examination and by logging symptoms.

Examination

A healthcare provider will examine the ears using an otoscope (a handheld tool with a light and a magnifying lens used to look inside the ear).

Your healthcare provider will look for:

• Cloudy red, yellow, or swollen eardrums
• Signs of fluid behind the eardrum or in the ear canal
• Small tears on the eardrum
  

Your healthcare provider may also pulse sound waves against the eardrum using a small probe (a tympanometry test). This is used to see how well the eardrum moves in response to sound.

Symptoms

Classic symptoms of an ear infection often begin after a cold. They include:

• Rapid onset of an earache
  
• A feeling of fullness/pressure
• Fluid draining from the ear (yellow, brown, or white, not earwax)
• Feeling dizzy or off-balance
• Trouble sleeping
• Loss of appetite
• Trouble hearing

Symptoms in infants and children include the above, plus:

• Irritability/crying
• Pulling or rubbing the ear
• Snoring or breathing through the mouth
• Fever
  

Guidelines for Using Antibiotics for an Ear Infection

According to the AAP guidelines, all babies under 6 months who develop an ear infection should be treated with antibiotics. Children between 6 months and 2 years also should get antibiotics if their pediatrician is certain they have a bacterial ear infection.

A child with severe symptoms, such as extreme pain or a fever over 102.2 F, should also be treated with antibiotics even if the healthcare provider isn't 100% certain a bacterial ear infection is the cause.

Treating Children with Chronic Health Issues

Children with certain chronic health conditions should be prescribed antibiotics for ear infections. This includes those with:

• Down syndrome
• Immune system problems
• A cleft palate
• A cochlear implant

Any child diagnosed with a previous ear infection within the past 30 days and those with chronic fluid in the ears should also be prescribed antibiotics.

Ear Infection Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Choosing to Wait-and-See

Older children, and young children who are generally healthy, don't typically need antibiotics to clear up an ear infection. The AAP guidelines advise using an "observation option" (also known as wait-and-see) with the use of over-the-counter acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil, Motrin IB) for pain relief. The child is observed for two to three days and if symptoms do not improve or worsen antibiotics are recommended.

Pediatricians handle this scenario in different ways. Some have parents come back to the office, others will prescribe the medication over the phone, and some doctors will write out a "just-in-case" prescription for parents to have on hand.

the AAP guidelines recommend starting with amoxicillin, and moving on to a stronger medication after 48 to 72 hours if amoxicillin doesn't relieve symptoms or a child's fever stays at 102.2° F or above. After that, or as an alternative if a child is vomiting, one to three days of an intravenous or intramuscular antibiotic, such as ceftriaxone may be needed.

Alternatives to Antibiotics for Ear Infections

A 2016 systematic review concluded that there may be some benefit to treating ear infections with complementary and alternative medicine (CAM) using:

• Homeopathy
• Phytotherapy (treating or preventing illnesses using medicines made from plants/herbs)
• Xylitol (gum and lozenges)
• Vitamin D supplementation (to correct a deficiency)
• Probiotics (as a nasal spray)

Some of these strategies were noted as possibly being effective in treating and preventing ear infections in children, but more research is needed.

Preventing Ear Infections

The AAP also provides recommendations to reduce risk factors for ear infections, especially during infancy, by:

• Breastfeeding for at least six months
• Never bottle-feeding a baby while they are lying down
• Weaning from a pacifier after six months
• Keeping children of all ages away from second-hand smoke

Summary

It can be difficult to identify which ear infections are bacterial and which are due to viruses or other causes. The 2013 AAP guidelines help healthcare providers to know when antibiotics are an appropriate treatment for ear infections. Over-prescribing antibiotics can lead to bacteria resistant to antibiotics and unnecessary, or dangerous, side effects.

Alternative treatments have shown some promise in being able to provide additional relief to treat ear infection symptoms but more research is still needed. Other precautions (such as avoiding second-hand smoke and pacifier-weaning by six months) can reduce the number of ear infections a child may have.