Oral Antibiotics for Ear Infections

When you need them—and when you don’t

Antibiotics are strong medicines that can kill bacteria. For ear infections, doctors often prescribe oral antibiotics that you swallow in pill or liquid form.

However, eardrops can sometimes be safer and more effective than oral medicines. Here’s why:

Oral antibiotics have risks.

  • Oral antibiotics are more likely to cause resistant bacteria outside the ear. When that happens, these medicines will not work as well in the future. Illnesses will be harder to cure and more costly to treat.
  • Antibiotic eardrops kill the bacteria faster and more completely than oral antibiotics. Drops don’t go into the bloodstream, so more medicine reaches the infection.

Oral antibiotics have more side effects.

Oral antibiotics can cause more side effects than antibiotic eardrops. Side effects include diarrhea, nausea and vomiting, stomach pain, rash, headache, and dangerous allergic reactions.

Who should use antibiotic eardrops?

Antibiotic eardrops can be more effective and safer for:

  • People with Swimmer’s Ear, an infection caused by water in the ear.
  • Children who have tubes in their ears. The tubes prevent most infections behind the eardrum—an area known as the middle ear. If there is an infection, antibiotic eardrops can be given right through the tube.

What about over-the-counter eardrops?

Over-the-counter eardrops can often be effective for Swimmer’s Ear.

People who have a hole or tube in the eardrum should check with their doctor before using any kind of eardrops. The drops may cause pain, infection, or even damage hearing. For bacterial infections, the only eardrops they should use are the antibiotics ofloxacin (Floxin Otic and generic) or the more pricey combination drug ciprofloxacin-dexamethasone (Ciprodex).

Antibiotics can lead to more costs.

Most oral antibiotics don’t cost much. But if they don’t work well, you may need extra doctor visits, a hospital stay, and costly drugs. You may also miss work. Treatment of a severe infection that is antibiotic-resistant can cost more than $25,000.

Who should take oral antibiotics for ear infections?

  • Children without ear tubes should take oral antibiotics for middle-ear infections, especially when they have severe ear pain or high fever.
  • Children with ear tubes should take oral antibiotics if:
    • They are very ill.
    • They have another reason to be on an antibiotic.
    • The infection doesn’t go away with eardrops.

Oral antibiotics help treat Swimmer’s Ear when:

  • Infection spreads beyond the ear.
  • The person has other conditions, such as diabetes, that increase the risk of complications.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2017 Consumer Reports. Developed in cooperation with the American Academy of Otolaryngology-Head And Neck Surgery.