The 2004 American Academy of Pediatrics guidelines for the treatment of ear infections includes specific recommendation for which antibiotics should be used in different situations. Most ear infections do not need antibiotics at all.
If antibiotics are used, high-dose amoxicillin is the best choice for most children – along with treatment for their ear pain. If the child is allergic to amoxicillin, then Ceftin, Omnicef, or Vantin are the preferred choices. If the child is also allergic to all four of these, then Zithromax or Biaxin are the recommended alternatives. If the child with the ear infection has a fever over 102.2 F or is severely ill, then the best starting antibiotic is usually Augmentin. If the child is allergic to Augmentin, then 1 to 3 injections of Rocephin is usually the best choice.
Whatever the initial antibiotic, it should be changed if there is not clear improvement within 48 to 72 hours. High-dose Augmentin is usually the best follow-up choice. If the fever is still over 102.2, the child is severely ill, or allergic to Augmentin, then three days of Rocephin injections are recommended. If the child is allergic to Rocephin, then clindamycin is the antibiotic of choice. These guidelines can help many children avoid unnecessary rounds of ineffective antibiotics.