What happens if your ear infection won t go away with antibiotics

Q: Why is my ear infection getting worse with antibiotics?

The catch is that antibiotics dont work against viruses – if you use antibiotics on a viral ear infection, it can actually make the infection worse. Overuse of antibiotics can lead to a condition called antibiotic resistance, which means that the medicine becomes less effective at fighting off bacteria.

January 26, 2016
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Many parents bring their children with ear infections to Express Care, Urgent Care and even the Emergency Department to request antibiotics. But, sometimes, antibiotics aren’t the right choice. Most ear infections cure themselves without the help of antibiotics.

"An ear infection is a bacterial or viral infection that affects the ear. It becomes painful when buildups of fluid and inflammation occur in the air-filled space behind the eardrum," says Leanna Munoz, Mayo Clinic Health System nurse practitioner. "Signs and symptoms of infection often quickly show."

Munoz says a great way to tell if your child has an ear infection is if he or she starts showing the following symptoms:

Pain in the ear, especially while lying down
Pulling or tugging the ear
Difficulty sleeping
Difficulty hearing or responding to sounds
Fever or headache

Generally, an ear infection will improve within the first couple days and clear up within one to two weeks without any treatment. It is recommended to use the wait-and-see approach for:

Children age 6 to 23 months with mild inner-ear pain in one ear for less than 48 hours and a temperature less than 102.2 F
Children age 2 and older with mild inner-ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F

"Home remedies can help manage your child’s pain," adds Munoz. "Try placing a warm, damp washcloth over the affected ear. Most providers recommend over-the-counter medication, such as ibuprofen or acetaminophen, to relieve pain. Use these medications as directed on the label."

Your medical provider can suggest the best treatment for your child. Antibiotics may be beneficial for certain children with ear infections. Your provider can explain the potential side effects and concerns about antibiotics creating strains of resistant disease. If antibiotics are prescribed, be sure to use the entire antibiotic as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medication.

Ear infections are no fun for anyone.

An ear infection (otitis media) occurs when fluid builds up behind your eardrum in the middle part of your ear and causes swelling (inflammation). This can lead to significant pain and discomfort.

Since most ear infections are caused by bacteria, it’s typically best to treat individual cases with antibiotics.

But antibiotic treatment isn’t appropriate for every ear infection. There are a variety of factors to consider, including:

causes
severity
location of infection
your age

Recurring ear infections may also require a different approach.

If you’re considering ear infection antibiotics for yourself or a loved one, learn more about how these medications work and how they can be both helpful and possibly harmful.

Ear infections are most prevalent in young children. They’re often the byproducts of upper respiratory infections.

You or your child might experience other symptoms before the ear infection, including:

sore throat
runny nose
cough

If an upper respiratory infection is caused by bacteria, then it’s possible to have an ear infection at the same time.

An ear infection occurs when bacteria gets trapped in your middle ear. Bacteria known as Hemophilus influenza and Streptococcus pneumoniae are the most common bacterial culprits.

But an ear infection may still occur if you have a viral respiratory illness. As you recover, it’s possible for bacteria to travel to your middle ear and become trapped, leading to a secondary infection in your ears.

Types of ear infections

The most common type of ear infection is called acute otitis media (AOM).

AOM infections

AOM is more common in children because they have smaller eustachian tubes. Located between the middle ear and upper throat, these tubes are responsible for fluid drainage.

If this fluid doesn’t drain, a buildup and infection may occur. Fluid trapped in the middle ear behind your eardrum may also cause:

earache
drainage or discharge from the ear
fever

Other common infections

Other common types of ear infections include:

Otitis media with effusion (OME). The infection has cleared up, but fluid may still be stuck in the middle ear.
Chronic otitis media with effusion (COME). Fluid continues to build up on a recurring basis despite the lack of infection. This chronic condition can lead to serious side effects, such as hearing loss (especially in children).
Swimmer’s ear (otitis externa): occurs in the outer ear when water becomes trapped and promotes bacterial growth in the ear canal.

When antibiotics are used

Antibiotics are typically only prescribed for AOM.

OME and COME occur after an infection has already occurred. Antibiotics can’t treat fluid buildup if there’s no active infection.

An antibiotic may be prescribed for an active ear infection once your doctor has examined your ear and has determined you exhibit signs and symptoms of AOM or swimmer’s ear.

Frequent or recurring ear infections should also be addressed with a doctor. Due to concerns with antibiotic resistance, recurring ear infections or COME shouldn’t always be treated with antibiotics.

Depending on the severity of your ear infection, your doctor may hold off on prescribing antibiotics.

Antibiotic resistance

Depending on the circumstance, your doctor may hold off on prescribing antibiotics to help prevent the possibility of antibiotic resistance.

Biofilms

Another possible risk factor for antibiotic treatments of chronic ear infections is the development of biofilms. These antibiotic-resistant bacteria colonies tend to develop in children who have recurring AOM.

A mild ear infection may go away on its own. But most cases of moderate to severe ear pain require a visit to your doctor. You should also see your doctor if you’re experiencing ear discharge, fever, or chills.

Children with ear infections may constantly cry due to pain and discomfort. They might also tug or pull at the affected ear. See your doctor if symptoms don’t improve within 2 to 3 days, or if they get worse.

Other signs that you should see a pediatrician include:

fever of 102.2°F (39°C) or higher
sleeping difficulties
problems with hearing
lack of response to sounds (especially in infants)
verbal complaints about ear pain
balance issues and/or clumsiness

If your child has recently had a cold, you should be on the lookout for signs or symptoms of an ear infection.

Once you’re at the doctor’s office, a medical professional will look inside your ear with an otoscope to determine whether you have an infection.

Typical signs include fluid buildup in the ear canal and middle ear, along with a red and inflamed eardrum.

Depending on the severity of your symptoms, your doctor may recommend waiting a few days to see if your ear infection improves.

Some infections resolve on their own. But if the infection is severe, or if symptoms don’t improve after this time, then antibiotics may be warranted.

Chronic fluid buildup without an infection warrants additional testing from an ear, nose, and throat (ENT) specialist.

It’s especially important to diagnose young children so that they don’t encounter speech and language delays from loss of hearing.

If your doctor recommends antibiotics to treat a severe ear infection, they will likely recommend an oral treatment, such as amoxicillin (Amoxil).

Antibiotic ear drops

Antibiotic ear dropsmay be prescribed, especially for the treatment of swimmer’s ear.

Oral antibiotics

Oral antibiotics are typically prescribed for 7 to 10 days.

Be sure to finish your prescription. Even if you feel better after a few days, the infection may return if you stop taking your medication.

Talk to your doctor about other antibiotics you’ve taken in the past and whether they’ve worked or not. Symptoms that don’t improve within 3 days may need other treatments.

OTC pain relievers

In addition to prescribed antibiotics, your doctor may recommend an over-the-counter (OTC) pain reliever to help reduce fever, pain, and overall discomfort.

OTC pain relievers include acetaminophen (Tylenol) and ibuprofen (Advil). Check with your pediatrician about the correct dosage for your child. Don’t give ibuprofen to children younger than 6 months of age.

Your doctor may ask you to come in for a follow-up visit to ensure that the infection has completely cleared. Fluid may remain in your ear for several weeks after the infection is gone.

If you have hearing or balance problems, see your doctor.

In some cases: surgery

Ear infections often go away with time or with the help of antibiotics. However, some people may experience recurrent ear infections and fluid buildup, or have ear infections that won’t heal for months.

In children, these issues can lead to hearing loss, behavioral issues, and speech development delays.

In these instances, a surgery called a tympanoplasty may help. In this procedure, a doctor inserts tiny tubes, called tympanostomy tubes or grommets, into the eardrum. These tubes reduce the occurrence of ear infections and allow drainage of excess fluids.

The procedure is very common and poses minimal risks. An ear tube insertion is more common for children, who tend to suffer ear infections more often than adults.

Antibiotics can help treat an ear infection. But doctors are increasingly reserving them for severe cases only. This can help decrease the occurrence of antibiotic resistance.

Whether you take antibiotics or not, stay in touch with your doctor regarding your condition. Symptoms that don’t improve or become more severe may require follow-up treatments.

What happens if ear infection doesn't get better?

A chronic ear infection may cause permanent changes to the ear and nearby bones, including: Infection of the mastoid bone behind the ear (mastoiditis) Ongoing drainage from a hole in the eardrum that does not heal, or after ear tubes are inserted. Cyst in the middle ear (cholesteatoma)

Why is my ear infection getting worse with antibiotics?

The catch is that antibiotics don't work against viruses – if you use antibiotics on a viral ear infection, it can actually make the infection worse. Overuse of antibiotics can lead to a condition called antibiotic resistance, which means that the medicine becomes less effective at fighting off bacteria.

Why did antibiotics not help my ear infection?

In most cases, antibiotics are not needed. They do not work for ear infections caused by viruses. They do not help the pain. Usually, viral infections and many bacterial infections go away on their own in two to three days, especially in children who are over two years old.

How long is too long ear infection?

You should see a doctor if ear infection symptoms last longer than a day or two. Common symptoms of ear infections include ear pain, frequent fluid drainage of the ear, hearing problems, and headaches. You should not hesitate to contact your doctor soon after experiencing symptoms if they are intense.