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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 relieve the infection. In addition, decongestants and antihistamines are not recommended to treat 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. The most widely recommended “second line” antibiotics are probably amoxicillin with potassium clavulante, azithromycin, cephalosporins, or the injectable antibiotic ceftriaxone .

Penicillins

  • Amoxicillin
  • Amoxicillin and potassium clavulanate

Erythromycins

  • Azithromycin
  • Clarithromycin
  • Erythromycin-sulfisoxazole

Cephalosporins

  • Cefdinir
  • Cefpodoxime
  • Cefuroxime
  • Ceftriaxone

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 two 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

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 medicine 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.

  • Anaphaltic (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 medicine 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 immediately, 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 (Rocephin) 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.

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 three days without consulting your physician.

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 three days without consulting your physician.

Ear drops containing a local anaesthetic, like 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.

  • 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

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.

References:

Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/.

National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/.

USP DI. 21st ed. Micromedex; 2001.

9/23/2008 DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php: Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews. 2008(3). CD001727.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: 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.

Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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