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Medications for Middle Ear Infections

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Ear infections are often treated with antibiotics. Antibiotics are only effective against infections caused by bacteria. If an ear infection is caused by a virus, antibiotics will not treat the infection. In addition, decongestants and antihistamines are not effective in the treatment of an ear infection.
The medications listed below are commonly used for otitis media.
For acute otitis treated with antibiotics, most experts currently recommend initial use of high-dose amoxicillin, reserving other medications for use only when there is no improvement after 48 hours. Generally, the most widely recommended second line of antibiotics are amoxicillin with potassium clavulanate, azithromycin, cephalosporins, or the injectable antibiotic ceftriaxone.
The over-the-counter medications are used to treat fever and discomfort.

Prescription Medications

  • Amoxicillin
  • Amoxicillin and potassium clavulanate
  • Azithromycin
  • Clarithromycin
  • Erythromycin-sulfisoxazole
  • Cefdinir
  • Cefpodoxime
  • Cefuroxime
  • Ceftriaxone

Over-the-Counter Medications

Prescription Medications

All of the prescription medications listed below are antibiotics. In some cases, a specific antibiotic may be prescribed because it is effective against the particular organism causing the ear infection. Usually however, the specific organism is not known, and the physician will prescribe an antibiotic, such as high-dose amoxicillin, that is effective against most of the organisms commonly associated with ear infections. Because some bacteria have developed resistance to many antibiotics, your physician may have to try several antibiotics before the infection is cured. The medications listed below are only a selection of those frequently used to treat otitis.
Unnecessary antibiotic usage leads to antibiotic resistance that may make future ear infections and serious infections, like pneumonia, more difficult to treat. For this reason, many experts recommend that children with otitis who are older than 2 years may not need antibiotics until a 2-3 day trial with pain relievers alone has been attempted and found to be unsuccessful. Some mild forms of otitis, especially if caused by a virus, are self-limiting and do not require antibiotics.
Any antibiotic can cause overgrowth of fungus and produce fungal rashes.
Penicillin Medications
Common drugs include:
  • Amoxicillin
  • Amoxicillin and potassium clavulanate
Penicillins are used to treat bacterial infections. These drugs may be provided in a liquid suspension, which is easier to give to small children, chewable tablets, or pills. Treatment usually involves 2-3 doses per day for at least 10 days, although some doctors are investigating the use of shorter treatment times. It may take several days before the medication takes effect.
Possible side effects include:
  • Rash
    • This can be due to allergy to penicillin and may be a serious problem.
    • It can also be a nonallergic side effect.
    • If skin rash develops, stop taking the medication and contact the doctor.
  • Anaphylactic (severe allergic) reaction
  • Vaginal itching or burning
  • Nausea, stomach pain, diarrhea
Common drugs include:
  • Azithromycin
  • Clarithromycin
  • Erythromycin-sulfisoxazole
These drugs may be used if you have a known allergy to penicillin or develop one during treatment. Some erythromycins are taken with food, while others are not. Your doctor, nurse, and pharmacist can advise you about the specific medication you are using. While widely used, these medications are not included on many experts' lists of best acute otitis treatment.
Possible side effects include:
  • Abdominal pain, nausea, and vomiting which can be fairly severe at times
  • Allergic reactions, including hives and respiratory difficulties
  • Loose stools, flatulence
  • Headache
If you experience these serious side effects, stop taking the medication right away, and seek emergency medical care immediately.
Common drugs include:
  • Cefdinir
  • Cefpodoxime
  • Cefuroxime
  • Ceftriaxone
Like the erythromycins, these medications may be used if previous medications were ineffective against your infection. They are usually provided in a liquid suspension (for children) or in capsules and are taken 2-3 times a day for 7-10 days. You should not take these medications if you are allergic to cephalosporins. Some children who are allergic to penicillin are also allergic to cephalosporins. Be sure to tell your doctor about any medication allergies. Ceftriaxone can be effective against otitis when given as a single shot, and a 3-day course has been shown to be better in more complicated cases.
Possible side effects include:
  • Rashes, redness
  • Itching
  • Extreme itching, hives, or faintness after a dose may be a sign of a serious allergic reaction and may require emergency medical care.

Over-the-Counter Medications

Ibuprofen helps to reduce fever, pain, and inflammation and can be useful during the early days of an ear infection. Ibuprofen can be taken with food or alone, although it may cause stomach upset if taken on an empty stomach. Do not use ibuprofen for more than 3 days without consulting your doctor.
Possible side effects include:
  • Stomach pain
  • Allergic reactions, including wheezing, facial swelling
Acetaminophen helps reduce pain and fever. It is less likely to cause stomach upset than ibuprofen, but might be less effective in reducing fever. This drug may be taken alone or with food, but it should not be used with other products containing acetaminophen, such as certain cold preparations. Do not use acetaminophen for more than 3 days without consulting your physician.
Ear Drops
Ear drops containing a local anaesthetic (such as ametocaine, benzocaine, or lidocaine) are used for temporary relief of ear pain. In children, ear drops can help decrease pain, especially when the drops are used with oral pain relievers.
If you are also taking antibiotics, the pain-relieving drops are usually only needed for the first 1-2 days of treatment. If your pain lasts longer, it may mean that the infection is not responding to antibiotic treatment.
If there is a chance that the eardrum has ruptured, do not use ear drops.

When to Contact Your Doctor

  • Continued or worse ear pain after several days of treatment
  • Develop a high fever, nausea, vomiting, or diarrhea
  • Develop hives, a rash or breathing difficulties
  • Drainage from the ear
  • Trouble hearing
  • Difficulty with balance

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.


About antibiotic use and resistance. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/getsmart/community/about/index.html/URI/ear-infection.html. Accessed November 16, 2016. Accessed September 27, 2017.
Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM. Updated May 17, 2016. Accessed September 27, 2017.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx. Updated May 12, 2017. Accessed September 27, 2017.
Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx. Updated February 22, 2013. Accessed September 27, 2017.
9/23/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev. 2008;(3):CD001727.
6/5/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2009;(2):CD005657.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
  • Review Date: 09/2017
  • Update Date: 09/17/2014