The most common prescription for an ear infection is an oral antibiotic, typically amoxicillin or amoxicillin-clavulanate, though the specific medication depends on which part of the ear is infected, the patient’s age, and how severe the symptoms are. Some ear infections also call for prescription ear drops, pain-relieving drops, or in certain cases, no antibiotic at all.
Middle Ear Infections in Children
Middle ear infections (acute otitis media) are overwhelmingly a childhood problem, and amoxicillin remains the go-to antibiotic. The American Academy of Pediatrics recommends a high dose of 80 to 90 mg per kilogram of body weight per day, split into two doses. This higher dosing helps overcome bacteria that have developed partial resistance to the drug.
If a child has taken amoxicillin within the past 30 days, has an eye infection at the same time, or doesn’t improve after a few days, the prescription typically shifts to amoxicillin-clavulanate. This version pairs amoxicillin with an ingredient that blocks a defense mechanism some bacteria use to resist the antibiotic.
How long a child takes antibiotics depends on age. Children under 2 generally get a 10-day course. Kids between 2 and 5 take antibiotics for 7 days, while children 6 and older often need only 5 days.
When Antibiotics Can Wait
Not every ear infection needs immediate antibiotics. The CDC outlines a “watchful waiting” approach where you observe your child for 2 to 3 days, giving the immune system a chance to clear the infection on its own. This applies to children 6 months and older if they have mild ear pain, a temperature below 102.2°F, and symptoms lasting less than 2 days. For children between 6 and 23 months, watchful waiting is only appropriate when a single ear is infected. Children 2 and older can qualify even if both ears are involved.
During the observation period, your child’s doctor may write a backup prescription you can fill if symptoms worsen or don’t improve. This strategy helps reduce unnecessary antibiotic use, which contributes to drug resistance over time.
Middle Ear Infections in Adults
Adults with a middle ear infection are usually prescribed amoxicillin-clavulanate rather than plain amoxicillin. The standard adult dose is 875 mg of the amoxicillin component taken twice daily. For more severe infections, or for adults over 65, those with weakened immune systems, or those who have recently taken antibiotics, a higher-dose extended-release version may be prescribed instead.
Alternatives for Penicillin Allergies
If you’re allergic to penicillin, the alternatives depend on how severe your allergy is. For a mild allergy (a rash, for example, rather than a serious reaction like throat swelling), doctors can typically prescribe a cephalosporin antibiotic instead. The most common options are cefdinir, cefpodoxime, and cefuroxime, all taken orally for 5 to 10 days.
For a severe penicillin allergy, cephalosporins share enough chemical similarity that they may not be safe either. In these cases, a fluoroquinolone antibiotic like levofloxacin may be considered, though this class of drug carries more potential side effects and is reserved for situations where safer options are off the table.
Outer Ear Infections (Swimmer’s Ear)
Infections of the ear canal, often called swimmer’s ear, are treated differently from middle ear infections. Because the infection sits in the outer canal rather than behind the eardrum, prescription ear drops work better than oral antibiotics. The drops deliver medication directly to the infected tissue at much higher concentrations than a pill could.
The most commonly prescribed drops combine an antibiotic with a steroid. One widely used combination pairs ciprofloxacin (which kills bacteria) with dexamethasone (which reduces the redness, swelling, and itching). These drops are typically used for about 7 days. Your doctor may also place a small wick in a badly swollen ear canal to help the drops reach deeper tissue.
Fungal Ear Infections
When an outer ear infection is caused by fungus rather than bacteria, standard antibiotic drops won’t help. Fungal ear infections, called otomycosis, are more common in warm, humid climates and sometimes develop after prolonged use of antibiotic ear drops, which can kill off bacteria and let fungus take over. Prescription clotrimazole ear drops are a typical treatment, applied twice daily (about 12 hours apart) for 14 days.
Prescription Pain Relief Drops
For the intense ear pain that often accompanies a middle ear infection, doctors sometimes prescribe analgesic ear drops alongside antibiotics. The best-known formulation combines antipyrine and benzocaine, two pain-relieving ingredients that numb the ear canal and reduce inflammation. These drops (sold under brand names like Aurodex) can also help soften earwax buildup. It’s worth noting that this particular combination has not gone through the FDA’s current approval process for safety and effectiveness, so some providers prefer to recommend over-the-counter oral pain relievers like ibuprofen or acetaminophen instead.
Ear Tubes for Recurring Infections
When ear infections keep coming back, a minor surgical procedure to place tiny tubes in the eardrums may be recommended. The threshold used by ear, nose, and throat specialists is generally three infections within six months, or four infections within a year with at least one occurring in the most recent six months. The tubes allow fluid to drain from behind the eardrum and equalize pressure, which makes the middle ear a less hospitable environment for bacteria.
Tube placement is a short outpatient procedure done under brief general anesthesia in children. The tubes typically stay in place for 6 to 18 months before falling out on their own as the eardrum heals. During that time, most children experience significantly fewer infections, and any infections that do occur can often be treated with ear drops alone rather than oral antibiotics.