The Best Ear Infection Treatments: Antibiotics and OTC Medications

If you or your child has ever had an ear infection, you know that they can be quite uncomfortable — and even painful. Though anybody can develop an ear infection, they’re more common in children. 

Ear infections are painful, but they’re highly treatable. In fact, many ear infections may resolve on their own. But pain relievers and antibiotics are sometimes needed.

What is an ear infection?

There are three types of ear infections: outer, middle, and inner ear infections.

Ear infection treatment options

If you or your child has symptoms of an ear infection, it’s a good idea to seek medical care. A healthcare professional will typically examine your ears with an instrument called an otoscope to diagnose an ear infection.

Treatment for an ear infection depends on the type of ear infection you have. For outer and middle ear infections, this often includes antibiotics and over-the-counter (OTC) pain relievers. 

However, treating an ear infection isn’t a one-size-fits-all approach. Your age, symptoms, and infection type come into play when deciding whether you need an antibiotic for an ear infection.

1. Watchful waiting

If your child has mild symptoms of a middle ear infection, your healthcare team may recommend the watch-and-wait approach. These symptoms include: mild ear pain, a temperature lower than 102.2°F, and symptoms lasting less than 2 days. 

The wait-and-see approach is exactly what it sounds like. It involves waiting 2 to 3 days to see if your child’s symptoms improve without an antibiotic. Most ear infections are actually caused by viruses, so antibiotics won’t help your child fight off the infection. It’s impossible to tell whether an ear infection is from a virus or bacteria just by looking at the eardrum. There may be other clues that can point to a bacteria or virus as the culprit. But, sometimes, it’s not possible to know for sure. 

Waiting 2 days gives the immune system a chance to fight off a virus. If symptoms get better and the ear doesn’t look as swollen, that means a virus was causing the infection. If things aren’t getting better, then the infection is more likely from bacteria and it’s time to start antibiotics. 

However, as a parent, you need to be comfortable with this approach. Some parents prefer to opt for antibiotics right away, and this is OK, too.

2. Over-the-counter medications for ear infections

Over-the-counter (OTC) pain relievers won’t treat the underlying cause of an ear infection, but they can make it more tolerable.

Oral OTC pain relievers — like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Motrin, Advil) — can help alleviate short-term pain and fever from any type of ear infection. You can take them alone or switch back and forth between them.

Keep in mind: Ibuprofen should generally be avoided in children younger than 6 months, unless your healthcare team recommends it. Aspirin is an NSAID that should also be avoided in kids and adolescents younger than 19 years because of the risk of Reye’s syndrome. This is a dangerous condition that can cause brain swelling, liver damage, and other serious complications.

3. Antibiotics for ear infections: Kids

Many antibiotics can treat middle ear infections in kids. But kids with one infected ear and mild symptoms may not need an antibiotic, since the infection could go away on its own. 

Kids often only need an antibiotic in these situations:

• They’re younger than 6 months.

• They’re younger than 2 years with an infection in both ears.

• They’re at least 6 months old with moderate or severe ear pain that lasts at least 2 days.

• They’re at least 6 months old with a temperature of 102.2°F or higher. 

• A repeat ear exam after 2 days (48 hours) doesn’t show signs of improvement.

Amoxicillin is a first-choice antibiotic for treating middle ear infections in kids. Amoxicillin is a type of penicillin antibiotic. It comes as tablets and capsules, as well as an oral suspension (liquid).

Amoxicillin dosages in kids are based on body weight. It’s often taken by mouth 2 times a day. Treatment usually lasts 10 days, but your child’s symptoms should start to improve within about 3 days.

Augmentin (amoxicillin / clavulanate) is a go-to medication for kids who have taken amoxicillin within the past 30 days. It’s also a good choice if your child has pink eye and an ear infection at the same time. 

Remember: Let your pediatrician know if your child has a penicillin allergy. They can recommend another antibiotic for otitis media, such as azithromycin or a cephalosporin antibiotic, like cefdinir.

4. Antibiotics for ear infections: Adults

The best ear infection treatment options for adults are similar to those for kids. Adults with middle ear infections should receive an antibiotic to prevent potential complications down the line. 

Amoxicillin is a first-choice antibiotic for adults with otitis media. It’s typically taken by mouth 2 to 3 times daily for 5 to 10 days. Your symptoms should start to improve within 3 days after starting it. Augmentin is a common alternative if amoxicillin isn’t effective for you.

Like kids, adults with a penicillin allergy have other options. These include cephalosporin antibiotics, such as cefdinir or cefpodoxime. Azithromycin could also work.

5. Ear drops for ear infections

Adults and children with swimmer’s ear usually need treatment with ear drops. You may need to use antibiotic ear drops, like ofloxacin (Floxin) or a combination ear drop that contains both antibiotics and a steroid, like ciprofloxacin / dexamethasone (Ciprodex). The steroids help calm inflammation in the ear canal. This can reduce pain and make it easier for antibiotics to get into the ear.

Acetic acid ear drops can also help with swimmer’s ear. These are mild antiseptics. They’re often combined with steroids to help calm inflammation and fight off the ear infection. 

Antibiotic ear drops can treat ear infections in kids who have ear tubes due to frequent ear infections. Swimmer’s ear can also be treated with antibiotic ear drops. Ciprodex (ciprofloxacin / dexamethasone) and ofloxacin are two examples.

You may need to take oral antibiotics if you don’t get better with antibiotic ear drops.

6. Natural and home remedies for ear infections

There are some simple things you can do at home to keep yourself comfortable, including:

• Drinking lots of fluids 

• Getting plenty of rest

• Applying a warm or cool compress to your outer ear

• Adjust your sleeping position so you don’t sleep on the side with an ear infection

When should you seek medical care for an ear infection?

Some middle ear infections go away on their own. 

Mild swimmer’s ear can go away on its own, too, but it usually takes a few weeks.

Ear infections can lead to more serious infections and may cause complications down the road. Getting treatment can help you avoid complications and feel better faster. It’s a good idea to get care within 24 to 48 hours of developing ear infection symptoms. 

Reach out to your healthcare team right away for immediate help if you or your child experience:

• Fever

• Hearing loss

• Fluid, pus, or discharge from the ear

• Eye redness or discharge

• Swelling, redness, or pain behind the ear

• Headaches

How can you prevent ear infections in the first place?

You can prevent middle ear infections by staying up to date with vaccines. Studies show that pneumonia and flu vaccines may help prevent otitis media. Pneumonia vaccines protect against common bacteria that cause ear infections. And flu vaccines protect against viruses that may lead to ear infections. The Haemophilus influenzae type b (Hib) vaccine (ActHIB, Hiberix, PedvaxHIB) can also help.

You can prevent swimmer’s ear by not getting water in your ears. Make sure to dry the outside of your ears after swimming. 

Washing your hands often with soap and water can prevent the spread of germs and lower your risk of picking up viruses that cause middle and inner ear infections.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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