For a child who has never had an ear infection or hasn't been on antibiotics for the past 30 days, the first drug I use to treat him is usually liquid amoxicillin -- the pink, bubble-gum-flavored kind. But if your child has recently been treated for an ear infection, it's likely that he's infected with a strain of bacteria that is resistant to amoxicillin. If that's the case, there are several stronger antibiotics your physician may try, including Augmentin, Zithromax, and Biaxin. After starting oral antibiotics, your child should begin to feel better in two or three days, but you must always finish the complete prescription.
It's also important to take him in for a follow-up visit so the doctor can ascertain that the infection has indeed cleared up. Once the infection is gone, it's common for fluid to remain in the middle ear, and that means bacteria can get into it and cause a repeat infection. In about two-thirds of children this remaining fluid will clear in one month, and in 90 percent it will clear in three months. Your doctor will monitor the situation at subsequent visits to make sure your child does not get another infection in the meantime and that the fluid doesn't remain for more than six months. That's because fluid in the middle ear for a prolonged period can result in temporary hearing loss, which is especially problematic for young children learning how to talk. Although studies have shown that there's no long-term impact on a baby's or toddler's language development, the hearing loss is a concern and may mean that your child requires ventilating or tympanostomy tubes. These small plastic or metal tubes are placed in the eardrums using a minor surgical procedure to help drain the fluid and keep it from collecting. A child's hearing returns to normal once the fluid drains. After they have tubes inserted, many of my patients get significant relief from their ear infections. The tubes stay in place until they fall out on their own. Half of the children will have to get tubes put in again, but the other half will have already outgrown ear infections by that time.
Some guidelines recommend waiting until a child has documented hearing loss before putting in tubes. I don't wait that long in my practice, but unfortunately some insurance companies deem the surgery unnecessary until there is hearing loss. If tubes are a possibility for your child, call your insurance company to learn about its policy in advance.