When is antibiotic treatment recommended for middle ear infection?

Middle ear infections can follow a cold and may improve as the body clears the infection. A clinician examines the eardrum and considers ear pain, fever, discharge, hearing change, age, general health, and whether symptoms are improving. Antibiotics are not useful for every episode, especially when the cause is not bacterial.

A child who is very young, has infection in both ears, has fluid or discharge, or is significantly unwell may need closer assessment. Adults with repeated episodes or unusual symptoms may also need a different evaluation.

Use the pain-relief plan recommended for the person’s age and health, encourage fluids, and rest. Do not put cotton buds, oil, or unprescribed drops into the ear, particularly if the eardrum may be perforated. A pharmacist or clinician can help choose suitable medicines.

If antibiotics are prescribed, give or take them at the stated times and complete the prescribed course unless the prescriber changes it. Do not use a previous prescription for a new earache, because the cause and needed treatment may differ.

Seek prompt medical review if pain is severe, symptoms are worsening, fever persists, fluid or pus comes from the ear, or hearing becomes markedly reduced. Arrange review when symptoms are not starting to improve after the timeframe given by the clinician.

Seek urgent care for swelling or redness behind the ear, a new facial weakness, severe dizziness, confusion, or a child who is unusually sleepy, difficult to wake, or unable to keep fluids down.

Ask whether the eardrum shows infection, whether observation is reasonable, how to control pain safely, and what change would mean antibiotics or a follow-up examination is needed.