Ear Infections - Medications

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When suspecting complications, consult with an ear, nose, and throat specialist (otolaryngologist). This specialist may perform a tympanocentesis or myringotomy procedure 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

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.

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

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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 instead:

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

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

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

First-line treatment for severe AOM: