Infection of the inner ear, or acute otitis media, does not always require antibiotic therapy. Some people with symptoms such as ear pain, fever and a red eardrum may benefit from antibiotic therapy to speed resolution and prevent complications. Antibiotics are only effective against bacteria; they do not work against viruses, which are a common cause of ear infection. The fastest working antibiotics are those that target the causative organism.
Amoxicillin
Amoxicillin is listed as the drug of first choice when treating an ear infection with antibiotics. The American Academy of Pediatrics recommend it for adults and children. This antibiotic is related to penicillin, but has a broader spectrum, meaning it is effective against a greater number of bacteria. A seven- to 10-day course of therapy is usually recommended with administration two or three times a day.
Macrolides
Azithromycin or Clarithromycin are recommended as alternative first-line drugs in those who are allergic to amoxicillin by the American Academy of Family Physicians. Azithromycin has the advantage of once daily dosing for a five-day course. Clarithromycin is prescribed twice a day for 10 days.
Cephalosporins
Cefuroxime and cefdinir are also alternative first-choice antibiotics for the treatment of ear infections in adults and children. These are considered for treatment for patients with a history of milder allergic reactions to amoxicillin. They are both administered twice a day for seven to 10 days. Cefpodoxime is a similar drug available for treating children in a once-a-day dose for five days.
Amoxicillin-Clavulanate
When clavulanate is combined with amoxicillin, the antimicrobial spectrum is expanded significantly. Clavulanate inhibits an enzyme produced by bacteria that creates resistance to amoxicllin. It is advised for severe infections, or for those cases involving an immune suppressed patient or a recurrent infection. Amoxicillin-clavulanate is dosed twice a day for a 10-day course.
Ceftriaxone
Ceftriaxone is a cephalosporin antibiotic sometimes chosen to treat an ear infection. It is not available orally, however, and is administered as an intramuscular injection. In children, it is commonly given daily for three days in a row. The Johns Hopkins Antibiotic Guide advises use every other day for a total of three doses in adults. This drug is particularly useful for patients who cannot take oral medicine.
