Is it necessary to give antibiotics to a baby suffering from a fever and ear infection?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

The baby had a blocked and runny nose, developed a fever that went away after one to two days, and now has slight pus in one ear. The doctor confirmed it was an ear infection. I wanted to know if antibiotics are necessary. Please help.

Answered by Dr. Shyam Kalyan N

Hello,

Welcome to icliniq.com.

I went through your query and understood your concern. Usually, antibiotics are given depending on the weight of the baby. In your case, the nasal problem has spread to the ear and caused an infection in the ear. If the child's immunity was good, it should have restricted the infection in the nose and throat itself. However, since the infection has spread to the ear through the eustachian tube, antibiotics are usually prescribed while keeping the ears dry. This condition is called acute otitis media when the nasal or throat pathology causes an infection in the ear. This causes the discharge of the ear due to a break of the eardrum. The baby usually complains of pain during the same. Usually, the infection resolves by itself when the immunity kicks in but to be on the safer side, a course of antibiotics is usually given. However, I wanted to know the age and weight of the baby. I hope this has helped you. Kindly follow with the answer. Thanks and regards.

Patient's Query

Hello doctor,

Thanks for replying. What are the risks of waiting for a few days before starting antibiotics?

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

I suggest you follow the instructions mentioned below, 1. Give the syrup of Amoxicillin and Clavulanic acid (200 milligrams for five milliliters), five milliliters thrice daily for five days, to the baby. 2. Keep the ears dry, and do not let water enter the ears while bathing. 3. Do not put any external drops in the ear. 4. Feed the baby on breast milk exclusively till the baby is better. 5. Give the syrup Tylenol in case of fever, a decongestant, and an antihistaminic in case of congestion. I hope this has helped you. Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply. The fever has not come for the past two days.

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

What is the condition of the baby? What is the status of the fever, pain, pus, and feeds? Please follow up with the answers. Thanks and regards.

Patient's Query

Hello doctor,

The baby is eating well with no fever, no crying, and very light pus. However, his ear is still sore. Please help.

Answered by Dr. Shyam Kalyan N

Hello,

Please let me go through your history.

Patient's Query

Hello doctor,

Ok.

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

Is the pus very thick, foul-smelling, yellow, and blood-stained? When did the baby have a fever? Kindly follow up with the answers. Thanks and regards.

Patient's Query

Hello doctor,

Thanks for your reply. The pus is whitish-yellow in color and fever lasted for a few days.

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

In babies, the eustachian tube is wider, without much cartilaginous support, and more horizontal. This makes it prone to infections from the nose and throat. It is common in infants and kids that nose and throat problems cause ear discharge. Since the fever is down and ear discharge seems harmless in your baby, I suggest you wait for antibiotics. I suggest you give some symptomatic treatment for a few days and not initiate antibiotics. I hope this has helped you. Thanks and regards.

Patient's Query

Hello doctor,

Is there any chance of meningitis or a brain abscess if I wait for antibiotics?

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

The warning signs will be fever, dull baby, fewer feeds, and yellow purulent discharge. Meningitis chances are less but cannot be completely ruled out. A stiff neck and an inactive baby can be signs of meningitis. Has your baby developed neck support? Kindly follow up with the answer. I hope this has helped you. Thanks and regards.

Patient's Query

Hello doctor,

Thanks for your reply. Yes, the baby has developed neck support.

Answered by Dr. Shyam Kalyan N

Hello,

I suggest you do not worry about meningitis.

Patient's Query

Hello doctor,

What about the brain abscess? Is it possible that the ear infection could spread?

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

It is fairly common for babies to have ear problems after nasal or throat pathology. The reason is their short wider, more horizontal eustachian tube connecting the ear to the nose. Brain abscess and meningitis are the complications of acute otitis media, but it is unlikely in an infant when the fever has subsided. In case of a brain abscess, the baby will be inconsolably crying, having thick purulent discharge and a high fever. I hope this has helped you. Thanks and regards.

Patient's Query

Hello doctor,

What if the fever does not return to normal?

Answered by Dr. Shyam Kalyan N

Hello,

Does your baby cry when you touch his external ear?

Patient's Query

Hello doctor,

Yes, the baby cries on touching his ear.

Answered by Dr. Shyam Kalyan N

Hello,

Does he cry even on a mild.touch or when you pull the pinna?

Patient's Query

Hello doctor,

Yes, his ear is very painful.

Answered by Dr. Shyam Kalyan N

Hello,

Are his both ears painful?

Patient's Query

Hello doctor,

Only one ear is painful.

Answered by Dr. Shyam Kalyan N

Hello,

Did you insert q tip or anything prior to his pain problem?

Patient's Query

Hello doctor,

We cleaned the ear lightly but did not insert anything into the ear.

Answered by Dr. Shyam Kalyan N

Hello,

Welcome back to icliniq.com.

According to history, the baby can have either of the two issues. He may either have acute otitis media or an external ear infection. I suggest you watch for the warning symptoms like fever, purulent discharge, dullness, and decreased feeds. When such symptoms occur, I suggest you consult an ear, nose, and throat specialist who can see the condition of the eardrum. I also suggest you keep the ear dry. I hope this has helped you. Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply.