Ear Infections and Antibiotics: Do You Need a Script?

Ear infections are an all-too-common ailment, especially in children, and they can be downright painful. With World Hearing Day shining a spotlight on ear health, it’s a great time to understand how ear infections affect our hearing and when antibiotics (a "script" or prescription) are actually needed. We often worry about ear pain or a child tugging at their ear and wonder if antibiotics are required, or if an online doctor can provide prescriptions online to fix the problem quickly. This blog post will break down the common types of ear infections, their symptoms, and guide you on when antibiotics are necessary—and when they’re not. Along the way, we’ll discuss how to use treatments safely to protect your long-term hearing health, and how Australians can conveniently access online prescriptions or medical advice through telehealth services like NextClinic.

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Common Ear Infections: Otitis Media vs. Otitis Externa

Not all ear infections are the same. The ear has three parts (outer, middle, inner), but the two most common infection sites are the middle ear and the outer ear​. Here’s a quick overview of these common ear issues:

• Middle Ear Infection (Otitis Media): This occurs behind the eardrum in the middle ear space. It often comes on after a cold or respiratory infection, when congestion and fluid build-up in the Eustachian tube (the tube connecting the middle ear to the back of the throat) allow viruses or bacteria to thrive. Children are particularly prone to middle ear infections due to having smaller Eustachian tubes​. In fact, about four out of five children will experience a middle ear infection at least once​. Otitis media can be acute (a short-term infection) or chronic (repeated or long-lasting infections).
• Outer Ear Infection (Otitis Externa or “Swimmer’s Ear”): This affects the ear canal, the tube between the outer ear opening and the eardrum​. It often happens after swimming or if water stays in the ear canal, creating a moist environment for bacteria or fungi to grow​. It can also be triggered by injuring the ear canal (for example, overly aggressive cleaning with cotton buds)​. Otitis externa earns the nickname “swimmer’s ear” because it’s frequently caused by water exposure​.

Key differences: Middle ear infections typically happen behind the eardrum (you usually can’t see anything from the outside) and might follow a runny nose or cold. Outer ear infections happen in the ear canal; the outer ear or canal may look red or swollen, and touching the ear can hurt. Despite different locations, both types cause ear pain and can affect hearing temporarily. Let’s look at symptoms in more detail.

Symptoms and Signs of Ear Infections

How do you know if it’s an ear infection? Symptoms can vary a bit between otitis media and otitis externa, but there’s a lot of overlap. Common signs and symptoms include​:

• Ear pain or ache: Ranging from mild to severe. In middle ear infections, pain might worsen when lying down; in outer ear infections, the ear often hurts more when you tug or press on it.
• Fluid or pus draining from the ear: This can happen especially if the eardrum bursts from a middle ear infection, relieving pressure and letting fluid out​. In otitis externa, you might see discharge or pus in the ear canal as well.
• Difficulty hearing: Sounds may be muffled or hearing might be reduced due to fluid behind the eardrum or blockage in the ear canal​. This is usually temporary and improves as the infection clears.
• Feeling of fullness or pressure: Particularly with middle ear infections, people (or older kids) might complain their ear feels blocked or has pressure due to fluid build-up.
• Fever: Especially common in kids with middle ear infections, a fever or general illness can accompany the earache. An infant might only show fever and irritability as signs of an ear infection​.
• Other symptoms in children: Young children or babies might tug at their ear, be unusually fussy or crying, have trouble sleeping, or lose appetite​. They can’t always say what hurts, but these behaviors, especially combined with a cold, might point to an ear infection.
• Outer ear redness or itchiness: In otitis externa, the ear canal skin can be red, swollen, and itchy​. There may be pain when chewing or when the outside of the ear is touched.
• Balance issues or dizziness: The ear plays a role in balance, so infections can sometimes cause vertigo (a spinning feeling) or unsteadiness, though this is less common​.

Most ear infections (especially middle ear infections) will cause discomfort for a few days. The good news is that ear infections do not usually cause long-term problems in most cases​. However, knowing when to treat them is important to avoid complications and to get relief from the pain.

When Do Ear Infections Need Antibiotics?

One of the biggest questions people have is whether they need antibiotics for an ear infection – essentially, do you need a prescription (script) for antibiotics or can it get better on its own? The answer depends on the type of infection and its severity.

Antibiotics are effective against bacterial infections. They won’t help if the infection is caused by a virus (like the common cold). Many ear infections, especially in the middle ear, are actually viral or will clear up without antibiotics​. Research shows most children with acute middle ear infections get better within about 3 days without antibiotics​. Because of this, doctors often recommend a “wait and see” approach for mild ear infections. Here are general guidelines on when antibiotics are needed:

• Severe Symptoms or High Fever: If someone (child or adult) has a high fever (e.g. above ~39°C)​, significant pain, or looks very unwell, it points to a bacterial infection that may need antibiotic treatment. For example, very severe ear pain, fever, or infections in both ears in a young child are reasons to start antibiotics promptly​.
• Very Young Children: Babies under 6 months old will generally be given antibiotics for a middle ear infection​. Their immune systems are still developing, and there’s a higher risk of complications, so doctors don’t usually “wait it out” in this age group. In children under 2 years, many doctors are also more inclined to treat with antibiotics, especially if both ears are infected or if symptoms are not mild​.
• Infections that Don’t Improve: Even if an ear infection starts off mild, if symptoms aren’t improving after 2–3 days, it may be time for antibiotics​. Middle ear infections usually start to get better in a couple of days; if pain or fever is persisting past 48 hours or worsening, that’s a red flag. Doctors might provide a prescription but advise you to wait 1-2 days to see if symptoms improve – if not, you fill the script. (This is sometimes called “delayed antibiotic prescribing.”)
• Confirmed Bacterial Infection or Pus: If a doctor looks in the ear and sees a bulging eardrum with pus, or the eardrum has burst and draining pus, they may prescribe antibiotics. A burst eardrum often relieves pain and will usually heal on its own, but antibiotics (oral or drops) might be used to clear any remaining infection and prevent complications.
• Outer Ear Infections (Swimmer’s Ear): Outer ear infections usually do require antibiotics, but in the form of ear drops, not pills​. Because otitis externa is often a bacterial infection in the ear canal, antibiotic ear drops (often combined with a steroid to reduce swelling) are the first-line treatment​. If an outer ear infection is very severe or has spread, then oral antibiotics might be added, but that’s less common. The key is that an outer ear infection always needs treatment – it won’t clear up on its own without some form of medicated drops​.

It’s worth noting that certain populations are at higher risk of complications from ear infections and thus more likely to need antibiotics even for what seems like a mild case. For instance, Aboriginal and Torres Strait Islander children in Australia have higher rates of ear infection complications and may be treated more proactively with antibiotics​. Your doctor will consider these factors when deciding on treatment.

When antibiotics are needed, a doctor’s prescription is required. That might mean a visit to your GP or an after-hours clinic. However, these days you can also get prescriptions online through telehealth services. For example, after a video or phone consultation via NextClinic (a telehealth platform in Australia), the GP can provide an online prescription for antibiotics if appropriate, sent straight to your email or pharmacy. This can be a relief if you’re in pain at home or managing a fussy child – you can get the medication you need without an in-person visit.

When Antibiotics Aren’t Necessary

Not every ear infection needs an antibiotic. In fact, overusing antibiotics when they aren’t needed won’t speed up relief and can lead to problems like antibiotic resistance. Many ear infections are caused by viruses or are mild enough that the body can fight off the infection on its own with a little time and rest. Here’s when you likely don’t need antibiotics:

• Viral Infections: If your ear infection is due to a virus (for example, it started with a bad cold), antibiotics won’t help at all, since they only work against bacteria​. The infection will run its course. You can still treat the symptoms (pain, fever) with pain relievers and other measures (more on that below), but you don’t need an antibiotic for the virus.
• Mild Middle Ear Infections in Older Kids/Adults: As mentioned, in children over about 2 and in adults, a mild middle ear infection will often clear up on its own in a few days​. If the pain is manageable and there’s no high fever or other severe symptoms, doctors often recommend watchful waiting for 2-3 days. During this time, use pain relief and rest, and see if things improve. Most of the time, they will – meaning no antibiotic necessary.
• Short-lived symptoms: Sometimes ear pain might actually not be an infection at all. For example, pressure from a flight or congestion can cause earache that resolves in a day. Or a bit of water trapped in the ear canal can cause discomfort that clears with home remedies. If symptoms go away within 24-48 hours, it’s unlikely you needed antibiotics. Ear infections generally last about a week, with the worst symptoms in the first 2-3 days​.
• Otitis Media with Effusion (Glue Ear): This is a condition where fluid stays in the middle ear after an infection, but there’s no active infection. It can cause muffled hearing or popping, but not acute pain or fever. Antibiotics are not useful for this fluid alone, since there’s no bacteria to kill. The fluid usually clears up by itself in weeks to a few months​. (If it doesn’t, doctors might consider placing grommets/ear tubes to drain it, but not straight to antibiotics.)

Why skip antibiotics if you don’t need them? Firstly, any medication can have side effects. Antibiotics can cause diarrhea, rashes, stomach upset, or even allergic reactions. Secondly, every time we use antibiotics, it can contribute to antibiotic resistance, where bacteria learn to survive the drugs. Using antibiotics when they’re not needed (like for viral infections or very mild cases) gives bacteria more chances to become resistant​. Down the track, that can make infections harder to treat. As one report put it, antibiotic eardrops or targeted treatment can work faster for ear issues, while unnecessary oral antibiotics can create resistant bacteria that make future illnesses “harder to cure and more costly to treat”​. In short, saving antibiotics for when they’re truly needed helps keep them effective.

The key takeaway: don’t insist on antibiotics for an ear infection without a proper evaluation. If your doctor says it’s likely viral or will likely clear up on its own, they’re not “withholding” treatment – they’re ensuring antibiotics will still work when you do need them. In the meantime, you can manage symptoms with safe at-home measures.

Treating Ear Infections (and Eardrops vs. Oral Antibiotics)

Whether or not you need antibiotics, you’ll want relief from the symptoms. Pain management is important: earaches can really hurt, especially at night. Using pain relievers like paracetamol (acetaminophen) or ibuprofen can help reduce pain and fever​. In children, use the correct dose for their age/weight and don’t exceed the recommended amount. Sometimes warm compresses on the ear can also soothe pain.

If you’re prescribed antibiotics, the form will depend on the type of infection:

• Antibiotic Ear Drops: These are the go-to for outer ear (swimmer’s ear) infections. They deliver the medicine directly to the infected area in the ear canal. Ear drops can sometimes be more effective than oral antibiotics for outer ear infections, because they put a high concentration of the antibiotic right where the bacteria are, without exposing the rest of the body​. In fact, studies have found antibiotic eardrops often kill bacteria faster and more completely in ear infections than oral meds, and with fewer side effects​. Using eardrops properly is crucial: you should lie down with the affected ear facing up, put in the prescribed number of drops, and stay lying down for a few minutes so the drops fully coat the ear canal​. Usually, doctors advise keeping the ear dry (no swimming) during the treatment and for about a week after​. Finish the full course of drops as prescribed, even if the ear feels better sooner.
• Oral Antibiotics: These are the typical liquid or pills you swallow. They are often used for middle ear infections if criteria for antibiotics are met (as discussed earlier). If you or your child are prescribed oral antibiotics, it’s important to finish the entire course as directed​. Stopping early can lead to the infection coming back or not fully clearing, and contributes to resistant bacteria. Common antibiotics for ear infections might include amoxicillin or others, depending on any allergies and local guidelines. If taking oral antibiotics, remember they can cause stomach upset – taking them with food can help, and consider a probiotic or yogurt if you get diarrhea (unless your doctor advises otherwise).
• What about over-the-counter drops or home remedies? There are some OTC alcohol/vinegar-based eardrops for swimmer’s ear prevention or mild cases (to dry out the ear), but check with a doctor before using any drops if you suspect an infection. If you have a burst eardrum or grommets (ear tubes) in place, certain drops can be harmful. Never put any drops in your ear if you have ear drainage or a known perforation unless they were prescribed for that use. Home remedies like olive oil drops or garlic oil are popular in folklore, but their effectiveness is not proven – and again, you wouldn’t want to trap anything in an ear that might have a perforation. It’s best to use treatments that are proven and recommended by healthcare professionals.

In addition to antibiotics or drops, doctors might also recommend decongestant nasal sprays or antihistamines if congestion is contributing to middle ear fluid (though evidence is limited on how well those help ear infections​). The mainstay remains pain relief and targeted treatment.

When to See a Doctor (and Options for Getting Help)

You should consider seeing a doctor for an ear infection if:

• Symptoms are severe: Intense pain, a high fever, or neck stiffness (the latter could indicate something more serious) should be evaluated promptly.
• No improvement: If after 2-3 days the pain is just as bad or worse, or new symptoms appear (like dizziness or swelling behind the ear), it’s time for medical review​.
• Ear discharge: Pus or fluid coming out of the ear is a sign of a perforation or a serious infection that needs a doctor’s attention​.
• Hearing loss or blocked ear persists: Temporary hearing muffling is common with ear infections, but if it doesn’t improve at all after the infection or keeps recurring, get it checked. Lingering fluid (glue ear) can affect hearing in the long run, especially in kids, and might need follow-up​.
• Young child or baby: As mentioned, littlies may need earlier intervention. If a baby is very irritable, has a fever, or you just suspect an ear infection, seeing a doctor is wise since they can’t tell us their symptoms clearly.

If you notice redness, swelling, or tenderness behind the ear (the bony area) and the ear is protruding outward, go to an emergency department. This could be mastoiditis, a rare but serious complication where the infection spreads to the bone behind the ear​.

For most routine ear infections, your GP (General Practitioner) can handle the evaluation and treatment. They will likely use an otoscope (the little scope with a light) to look in the ear and confirm if there’s an infection and what type​. Sometimes they’ll check the throat and nose too, since those are connected.

Now, regarding access to care: If you can’t get to your GP easily or quickly (say it’s the weekend, or you live remote, or you’re at home solo parenting a miserable toddler), remember that Australian telehealth services like NextClinic are available. Through NextClinic, you can have an online consult with a doctor who can assess your symptoms, albeit remotely. If they determine you need antibiotics or eardrops, they can provide online prescriptions sent directly to your pharmacy or via email. This means you can get the needed medication without waiting for an in-person appointment. NextClinic doctors can also issue medical certificates if you need a sick note for work or school due to the ear infection, and even provide specialist referrals if an ongoing problem warrants seeing an Ear Nose and Throat (ENT) specialist. This kind of convenient access to prescriptions online and medical advice can be a real relief when you’re dealing with a painful ear at odd hours or during lockdowns, etc. (Of course, if there are any red flag severe symptoms, an in-person exam or emergency visit might still be recommended by the telehealth GP.)

Call-to-action: Don’t hesitate to seek medical advice if you’re unsure. Ear pain can be miserable, and getting a proper diagnosis is important. With today’s telehealth options, you can consult a doctor and get prescriptions online from the comfort of home. NextClinic, for example, allows Australians to quickly obtain an online prescription or medical certificate after speaking with a qualified doctor, which is especially handy on weekends or holidays. Your hearing is precious – when in doubt, get it checked out!

Preventing Ear Infections and Protecting Your Hearing

While ear infections aren’t 100% preventable, there are steps to reduce the risk for you or your children, and to protect your long-term hearing health:

• Stay healthy & hygienic: Since many ear infections follow colds or flus, general illness prevention helps. Wash hands frequently and keep up to date with vaccinations (like the pneumococcal vaccine and annual flu shot) to reduce the likelihood of those infections that can lead to ear issues​.
• Avoid smoke exposure: Smoking or secondhand smoke increases ear infection risk in children​. Keeping kids (and yourself) away from cigarette smoke can lower ear infections.
• Breastfeeding and feeding position: For babies, breastfeeding (even for the first 6-12 months) can provide antibodies that lower infection risk​. If bottle-feeding, try feeding in a more upright position to prevent milk from entering the Eustachian tube.
• Ear hygiene – less is more: Don’t over-clean ears. Earwax actually protects the ear canal. Using cotton buds (Q-tips) or other objects can scratch the ear canal and introduce infection​. Also, never put anything (drops, oils, etc.) in the ear unless advised by a doctor.
• Keep ears dry (for swimmer’s ear): If you’re prone to outer ear infections, use earplugs or a swim cap when swimming, and dry your ears after any water exposure​. You can gently dry the outer ear with a towel and let any water drain out. Some people use a hairdryer on low/cool setting held at a distance to ensure dryness. Avoid swimming in polluted water as well.
• Treat allergies: Allergies can cause congestion and fluid build-up. Managing allergy symptoms might help reduce ear infection frequency for those who get them regularly due to sinus/Eustachian tube issues.
• Follow up on recurring infections: Repeated ear infections can sometimes lead to hearing issues (like temporary hearing loss or, in chronic severe cases, even permanent damage). If you or your child get multiple ear infections, discuss with a doctor. They might monitor hearing or recommend an ENT consult. In children, chronic fluid (glue ear) can affect speech/language development if it persists, so it shouldn’t be ignored. Treatments like grommet insertion can help drain fluid and ventilate the middle ear if needed.

By taking these steps, you’re not only trying to avoid the pain of an ear infection, but also looking after your long-term hearing health. World Hearing Day is a reminder that hearing matters – preventing infections (and treating them properly when they do occur) is part of keeping your ears healthy.

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Disclaimer

This medical blog provides general information and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your regular doctor for specific medical concerns. The content is based on the knowledge available at the time of publication and may change. While we strive for accuracy, we make no warranties regarding completeness or reliability. Use the information at your own risk. Links to other websites are provided for convenience and do not imply endorsement. The views expressed are those of the authors and not necessarily representative of any institutions.