Ear, Nose & Throat Ear Infections When to Use Amoxicillin for Ear Infections Antibiotics may not be needed to treat infections By Vincent Iannelli, MD Updated on March 13, 2024 Medically reviewed by John Carew, MD Print 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. Hero Images / Getty Images 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 eardrumsSigns of fluid behind the eardrum or in the ear canalSmall 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 earacheA feeling of fullness/pressureFluid draining from the ear (yellow, brown, or white, not earwax)Feeling dizzy or off-balanceTrouble sleepingLoss of appetiteTrouble hearing Symptoms in infants and children include the above, plus: Irritability/cryingPulling or rubbing the earSnoring or breathing through the mouthFever How Middle Ear Infections Are Diagnosed 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. Are antibiotic prescriptions declining? Antibiotics should only be used to treat bacterial illnesses. Because over-prescribing can lead to an antibiotic becoming ineffective, healthcare providers are prescribing them less to reduce the number of serious bacterial infections (such as MRSA) resistant to antibiotics. Sometimes antibiotics have side effects that can make a person more ill than they were initially. Common side effects include rash, dizziness, yeast infections, nausea, and diarrhea. More serious side effects include Clostridioides difficile infection (also called C. difficile or C. diff), which causes diarrhea that can lead to severe colon damage and death. 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. Download PDF Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Email Address Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. 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 Rocephin (ceftriaxone) may be needed. Regardless of the specific antibiotic prescribed, according to the AAP children under 6 and those with severe symptoms should stay on medication for 10 full days. Older kids may do well with just five to seven days of antibiotics. 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 effective in treating and preventing ear infections in children. Ear Tubes If ear infections keep reoccurring, or fluid stays trapped behind the ear, a tiny plastic or metal tube can be inserted into the eardrum to help drain the ear. These tubes fall out as the eardrum heals and need not be removed. While this procedure (called a myringotomy) is more common in children, it is also performed in adults. Preventing Ear Infections The AAP also provides recommendations to reduce risk factors for ear infections, especially during infancy, by: Breastfeeding for at least six monthsNever bottle-feeding a baby while they are lying downWeaning from a pacifier after six monthsKeeping children of all ages away from second-hand smoke What Causes Ear Infections? 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 been shown effective in relieving ear infection symptoms and in speeding healing. 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. 10 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute on Deafness and Other Communication Disorders. Ear Infections in Children. Schilder AG, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP, Venekamp RP. Otitis media. Nat Rev Dis Primers. 2016 Sep 8;2(1):16063. doi:10.1038/nrdp.2016.63 Middle Ear Infection: Overview. Institute for Quality and Efficiency in Health Care. 2019. Medline Plus. Tympanometry. Penn Medicine. Ear Infection (Middle Ear). Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media [published correction appears in Pediatrics. 2014 Feb;133(2):346. Dosage error in article text]. Pediatrics. 2013;131(3):e964-e999. doi:10.1542/peds.2012-3488 Duke Health. Why Antibiotics Aren't Always the Answer. Centers for Disease Control and Prevention. Be Antibiotics Aware Partner - Toolkit. Marom T, Marchisio P, Tamir SO, Torretta S, Gavriel H, Esposito S. Complementary and Alternative Medicine Treatment Options for Otitis Media: A Systematic Review. Medicine (Baltimore). 2016;95(6):e2695. doi:10.1097/MD.0000000000002695 Nemours KidsHealth. Ear tube surgery. By Vincent Iannelli, MD Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit