Antibiotics for ear infections: What are the options?

An ear infection can cause uncomfortable symptoms, and it’s usually due to a bacterial infection. Doctors prescribe antibiotics to treat them as they target the bacteria.

The best antibiotic for you will depend on many different factors. For example, amoxicillin (Amoxil) is generally the preferred drug for adults with otitis media (an infection of the middle ear that is the most common kind of ear infection) because of its effectiveness against most common bacterial infections.

Amoxicillin is a broad-spectrum antibiotic, meaning that it targets many different bacteria that can cause infection, including Streptococcus pneumoniae and Haemophilus influenzae. It’s generally well-tolerated, has a low risk of side effects, and is available in various formulations, making it a convenient and effective treatment for adults.

But there are different types of ear infections. Another common example is otitis externa, which affects the outer ear and is sometimes known as a swimmer’s ear. Usually, ear drops can help treat this kind of infection.

Consider speaking with a doctor if you think you have an ear infection for a proper diagnosis, appropriate dosage, and duration of treatment.

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Ear infections overview

Otitis media occurs when fluid builds up behind the eardrum through a narrow passage connecting the middle ear to the back of the throat called the eustachian tube, or the auditory tube.

Anyone can get this type of ear infection. But children between 6 months and 2 years of age are more likely to get otitis media because their eustachian tubes are smaller and more horizontal. Smaller eustachian tubes mean they’re less efficient at draining fluids than the ones in adults, which can lead to infections.

The most common cause of ear infections is the entry of bacteria or viruses into the ear.

Bacteria entering the middle ear, behind the eardrum, cause otitis media. Otitis externa can happen when water is left in the ear canal, for example, after swimming, which provides the perfect environment for bacteria to grow. It can also occur when there is damage to the skin of the outer ear.

Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis commonly cause ear infections.

Viruses such as respiratory syncytial virus and influenza (flu) can also increase the risk of developing ear infections.

Another common cause is eustachian tube dysfunction. When the eustachian tube becomes blocked or malfunctions, it impairs the proper drainage of fluids from the middle ear, creating an environment that more easily leads to infection. 

Additionally, certain factors may increase the risk of developing ear infections, including:

• exposure to secondhand smoke
• excess earwax
• allergies
• sinus infections
• air pollution and irritant exposure
• weakened immune function
• water left in the ear canal after swimming

When you have an ear infection, you might experience various symptoms, including:

• ear pain or discomfort 
• discharge from the ear
• a feeling of fullness in your ear
• temporary hearing loss
• fever

Antibiotics

Doctors commonly prescribe oral antibiotics, ear drops (either antibiotic or other types), and pain medication for treating ear infections. Here is a list of the most common antibiotics for ear infections:

Amoxicillin (Amoxil)

Amoxicillin is often considered the best option for treating middle ear infections due to its broad spectrum of activity against the bacteria that commonly cause this condition. 

Benefits of amoxicillin include:

• it’s usually well-tolerated
• it’s available in different oral formulations (liquid suspension, tablet, or capsules)
• it’s cost effective
• it’s effective against many common bacteria 

Commonly reported side effects include:

• diarrhea
• nausea 
• vomiting

Azithromycin (Zithromax)

A doctor may recommend azithromycin (Zithromax) for otitis media when the treatment requires an alternative to amoxicillin or a shorter treatment course. It is best for people with a known allergy to penicillin-based antibiotics.

Benefits of azithromycin include:

• convenient dosing (once per day for a shorter duration than amoxicillin)
• it’s effective against certain bacteria that are resistant to other antibiotics

Commonly reported side effects include:

• diarrhea
• nausea

Cefuroxime

Cefuroxime may be a suitable option for people with penicillin allergies or those requiring a broad spectrum of coverage against the bacteria that cause middle ear infections.

Benefits of cefuroxime include:

• it’s effective against a wider range of bacteria
• it’s available in various formulations, such as a tablet or a powder to make a solution for injection into a muscle or vein
• it can help treat people with a penicillin allergy

Commonly reported side effects include:

• diarrhea
• nausea

Ciprofloxacin (Cetraxal)

Ciprofloxacin (Cetraxal) is effective against a range of bacteria causing ear infections, and it’s available in the form of ear drops, which some people find easier to use. Ciprofloxacin helps treat outer otitis externa (outer ear infections) such as swimmer’s ear.

Benefits of ciprofloxacin include:

• it’s effective against specific bacteria
• it’s easy to use

Commonly reported side effects include:

• temporary discomfort or stinging sensation upon application
• headache
• itchiness of the ear

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Other treatments for ear issues

Ear drops

Commonly used ear drops for ear issues include:

Neomycin/colistin/hydrocortisone/thonzonium (Cortisporin-TC)

This prescription steroid ear drop is useful in reducing inflammation, itching, and discomfort in the ear, particularly for outer ear infections. 

Benefits of neomycin/colistin/hydrocortisone/thonzonium (Cortisporin-TC) include:

• it provides symptom relief in certain conditions such as swimmer’s ear or chronic otitis externa
• it’s easy to use

Commonly reported side effects of neomycin/colistin/hydrocortisone/thonzonium include:

• thinning of the skin
• burning or itching
• irritation or dryness

Neomycin/colistin/hydrocortisone/thonzonium may not be suitable for certain types of ear infections.

Carbamide peroxide (Debrox)

Carbamide peroxide (Debrox), which is available over the counter (OTC), can help soften and loosen excess earwax, making its removal easier. Excess ear wax may cause an ear infection. Removing it reduces your risk of getting an ear infection.

Benefits of carbamide peroxide include:

• it aids in the removal of excessive earwax
• it’s easy to use

Commonly reported side effects include a crackling or popping sound after administering the drops.

OTC options for pain relief

These include OTC pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil), which help reduce the pain and fever associated with ear infections. It’s important to remember that they don’t treat the infection itself.

Acetaminophen (Tylenol) 

Benefits of acetaminophen (Tylenol) include:

• it’s effective in reducing pain and fever
• it’s widely available without a prescription
• it’s suitable for people who cannot take nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil)

Commonly reported side effects include:

• skin rash 
• nausea and vomiting

Ibuprofen (Advil) 

Benefits of ibuprofen (Advil) include:

• it’s effective in reducing pain and fever
• it relieves inflammation in the ear
• it’s widely available without a prescription

Commonly reported side effects include:

• increased risk of allergic reactions
• risk of stomach upset
• increased bleeding risk

Summary

Choosing the best antibiotic to treat an ear infection is important for effective results. The best option will depend on the type or the cause of the infection.

For example, while doctors may prescribe several antibiotics, amoxicillin is often the first-choice option for treating middle ear infections due to its effectiveness against common bacteria. Antibiotics in ear drop form, including ciprofloxacin ear drops, can be helpful for outer ear infections.

Consider speaking with a doctor for a proper diagnosis and a personalized treatment plan to ensure you get the most appropriate antibiotic for your ear infection.

Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.