What Is the Best Antibiotic for Ear Infections?

The best antibiotic for a bacterial ear infection depends on the type of bacteria colonizing the ear canal.

Ear infections occur when bacteria or viruses get into the structures of the ear. Ear infections can occur in different parts of the ear:

• Ear canal (otitis externa, also called “swimmer’s ear”)
• Eardrum
• Middle ear (otitis media)

Symptoms of ear infections include:

• Fever 
• Ear pain
• Feeling of fullness in the ear
• Decreased hearing/hearing loss
• Ringing in the ear (tinnitus)
• Discharge from the ear (otorrhea)
• Nausea
• Vomiting 
• Spinning sensation (vertigo)

Additional signs of ear infections in young children and infants may also include:

• Pulling on the ear/rubbing the ear
• Fussiness
• Irritability
• Restless sleep
• Decreased activity
• Loss of appetite 
• Difficulty eating
• Diarrhea

Middle ear infection (otitis media) is usually caused by:

• Bacteria; the most common bacterial causes include:
• Streptococcus pneumoniae (also called pneumococcus)
• Haemophilus influenzae  
• Moraxella catarrhalis 
• Viruses, such as:
  • Common cold viruses
  • Respiratory syncytial virus (RSV)
  • Flu (influenza) 

Infections of the ear canal (otitis externa, also called “swimmer’s ear”) are usually caused by water that remains in the outer ear canal for an extended period of time, which, when combined with the earwax and debris already present in the ear canal, provided a moist environment for bacteria or yeast to grow and cause infection. While it’s commonly called “swimmer’s ear,” diving or bathing and showering can also permit just enough water into the ear to create a fertile breeding ground for infection.

Ear infections are diagnosed with a medical history and a physical exam. 

A healthcare provider uses an otoscope (an instrument that is a light with a cone at the tip) to look inside the ear canal and determine if an ear infection is present, and whether the infection affects the middle ear or ear canal.

Medications used to treat ear infections include:

• Pain medications
• Acetaminophen (Tylenol) 
• Ibuprofen (Advil, Motrin) 
• Pseudoephedrine (Sudafed) to ease ear pressure
• Antibiotic ear drops for infections of the ear canal (otitis externa)
• Neomycin (Ak-Spore HC, Cortisporin, Neotricin HC, Ocutricin-HC)
• Polymyxin B
• Ciprofloxacin otic
• Steroid ear drops for infections of the ear canal (otitis externa)
• Hydrocortisone (Cortisporin, Otocort, Poly Otic)
• Oral antibiotics for infections of the middle ear (otitis media), and severe infections of the outer ear
• Cephalexin (Keflex) or other cephalosporin antibiotics
• Amoxicillin
• Amoxicillin/clavulanate (Augmentin)
• Azithromycin (Zithromax)
• Erythromycin
• Trimethoprim/sulfamethoxazole (Bactrim)
• Doxycycline (Doryx)

For mild cases of ear infection, doctors often recommend watching and waiting before starting use of antibiotics, as many cases will go away on their own.  Consult your child’s pediatrician before giving any over-the-counter (OTC) medications to your child. 

Home remedies to relieve symptoms include:

• Warm compresses applied to the area to help soothe pain
• Over-the-counter pain eardrops (only use if specifically recommended by a physician)

Complications of ear infections are uncommon with proper treatment. Complications may include:

• Hearing loss: usually temporary but may become permanent if the eardrum or middle ear structures are damaged
• Infection that spreads to nearby tissues, such as infection of the mastoid bone, which helps drain middle ear fluid (mastoiditis)
• Eardrum tears: most will heal on their own within a few days, though in some cases surgery is needed to repair it
• Speech or developmental delays in infants and toddlers if hearing is impaired

You may be able to prevent ear some ear infections if you: 

• Use earplugs when swimming or diving
• Dry ears thoroughly after swimming 
• Never use cotton swabs inside the ear canal
• Wash hands properly to prevent the spread of viruses 
  • Use soap and warm water and wash for at least 20 seconds
• Do not smoke and avoid secondhand smoke
• Get vaccinated regularly as your doctor recommends
  • Flu vaccine
  • Pneumococcal vaccine (protects against Streptococcus pneumonia, a common cause of middle ear infections)
• Breastfeeding exclusively until a baby is 6 months old may decrease a child’s chance of getting ear infections