Ear pain and ear infections – what to do
Earache in adults and children, when it needs a clinic, why most ear infections do not need antibiotics, and the warning signs behind the ear that need urgent care.
Earache is common and usually settles
Most ear pain comes from a middle-ear infection behind the eardrum, often just after a cold, or from an outer-ear infection in the canal itself. Both are common in children. Most middle-ear infections improve within a few days without antibiotics, which is why guidelines favour pain relief and review rather than a prescription on the first day.
- Middle ear: deep pain, often with a recent cold, sometimes a fever, sometimes reduced hearing. A small child may pull at the ear, cry more than usual, or feed and sleep badly.
- Outer ear: pain when you tug the outer ear or press the little flap at the front, often itchy first, common after swimming.
- Discharge from the ear can mean the eardrum has perforated, which relieves the pain suddenly. It usually heals, but it needs to be looked at.
Pain relief first
Pain relief is the treatment that helps on day one. paracetamol (Panado) and, where suitable, ibuprofen (Nurofen) are the usual choices, dosed by weight in children. A warm cloth held against the ear can help too.
Medicines used for earache and ear infections in South Africa:
Paracetamol — Panado, Painamol, Tylenol, Pacimol
Mild to moderate pain; fever
Ibuprofen — Nurofen, Brufen, Advil, Ibupain
Mild to moderate pain; inflammation; fever; dysmenorrhoea
Amoxicillin — Amoxil, Betamox, Moxypen, Ospamox
Upper and lower respiratory tract infections; UTIs; skin infections; otitis media; H. pylori eradication
Ciprofloxacin Ear Drops — Ciprodex (with dexamethasone)
Otitis externa; chronic suppurative otitis media
When to go to the clinic
- A baby under six months with ear pain or a fever.
- Pain that is not improving after two to three days, or that is getting worse.
- Discharge, blood or pus from the ear.
- Hearing that has not returned after the pain settles.
- Repeated ear infections, or an ear that keeps discharging over weeks.
- Anyone with diabetes or a weakened immune system who has an outer-ear infection, which can become serious.
Common questions
- Do ear infections need antibiotics?
- Most middle-ear infections settle on their own within a few days, so guidelines start with pain relief and review. Antibiotics are used for young babies, severe or worsening infection, or when the ear is discharging.
- What can I give a child for earache?
- Weight-based paracetamol (Panado), and ibuprofen (Nurofen) where it is suitable for that child. Ask a pharmacist to confirm the dose for your child's weight rather than guessing from the box.
- Is it safe to clean ears with cotton buds?
- No. Cotton buds push wax deeper and can perforate the eardrum. If wax is a problem, ask a pharmacist or clinic rather than putting anything into the canal.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Adult Primary Care guide: symptom-based integrated approach to the adult in primary careNational Department of Health, South Africa
- Medicines Online Directory and approved patient information leafletsSouth African Health Products Regulatory Authority
- Clinical and public health guidanceWorld Health Organization
Last reviewed 11 August 2026.