How does prednisone work for ear infections?

In this article:

• Prednisone for ear infection
• Typical dosage of prednisone for ear infection
• Prednisone for ear infection side effects 
• Comparing prednisone with other treatments for ear infection
• The bottom line 

In this article

• Prednisone for ear infection
• Typical dosage of prednisone for ear infection
• Prednisone for ear infection side effects 
• Comparing prednisone with other treatments for ear infection
• The bottom line 

When the immune system kicks in, it can produce inflammation. However, inflammation isn’t always helpful and can lead to numerous medical conditions. Prednisone is a corticosteroid that suppresses immune system responses to relieve inflammation and treat conditions like arthritis, asthma, allergic reactions, inflammatory bowel disease, blood disorders, and more. It can also help treat swelling and other symptoms associated with ear infections. Here’s how. 

Prednisone for ear infection

To understand how prednisone can treat an ear infection, we first need to understand the condition itself. 

An ear infection (acute otitis media, or AOM) isn’t its own unique condition. Rather, it’s when the space behind the eardrum is infected by a virus or bacteria. The common cold, flu, strep throat, and even allergies can all lead to ear infections. These viruses, bacteria, and other irritants can inflame the Eustachian tubes, which go from the middle ear to the back of the throat. This may cause a buildup of fluid in the ear canal called middle ear effusion, leading to ear pain, trouble hearing, pressure, discharge, and other ear infection symptoms. 

That’s where prednisone comes in. “While it’s not typically the first-line treatment for ear infections, it may be considered for individuals with moderate to severe symptoms, especially when inflammation is a significant component of the condition,” says Hannah Cohan, board-certified Nurse Practitioner with the Medical Offices of Manhattan. 

“By reducing inflammation, prednisone helps alleviate symptoms, such as pain and swelling, promoting quicker healing,” adds Dr. Kubanych Takyrbashev, MD, a health and wellness advisor at NAO. “However, it’s crucial to note that prednisone is typically used alongside antibiotics or other treatments, depending on the specific circumstances of the ear infection. It’s not a standalone solution, but rather a complementary therapy that addresses the inflammatory aspect of the infection.”

Prednisone usually starts working within one to two hours, so it might begin relieving ear infection symptoms in just a few hours. Studies have shown that, compared to a control group, steroid treatment paired with an antibiotic can help resolve the infection faster in the short term but has a minimal effect on long-term symptoms like hearing loss. 

“When considering the use of oral steroids like prednisone or methylprednisolone for ear infections, it’s important for healthcare providers in primary care settings to examine the eardrum before initiating treatment,” Cohan says. “This examination helps ensure that the use of steroids is appropriate and safe for the patient’s specific situation.”

Typical dosage of prednisone for ear infection

According to the National Institutes of Health, the typical dosage of prednisone for adults is between 5 and 60 mg per day, depending on the condition it’s treating. For young children, doses are generally 0.05–2 mg per kg of body weight per day, depending on the condition. A full course of prednisone treatment for an ear infection typically lasts a few days to a week since the infections rarely last a long time. 

“If a patient experiences sudden hearing loss, high-dose prednisone therapy may be initiated promptly,” Cohan says. “This treatment regimen is typically overseen and directed by audiologists or ear, nose, and throat (ENT) specialists. The dosage of prednisone is often started at a high level and then gradually tapered down over a period of weeks to minimize potential side effects.”

Prednisone can come as an oral tablet, otic corticosteroid (ear drops), or topical nasal steroid. The healthcare provider will examine the severity of the ear infection and then decide which form and dosage might work best. 

Prednisone for ear infection side effects 

No medication is perfect, and like other drugs, prednisone comes with a risk of side effects. According to prednisone’s drug information provided by the U.S. Food and Drug Administration (FDA), some common side effects include:

• Headache
• Nausea
• Increased appetite
• Trouble sleeping
• Weight gain
• Fatigue
• Fluid retention
• Acne

In rare cases, it may also cause serious adverse effects. Contact your healthcare provider if you experience any of the following unwanted effects while taking prednisone: 

• Allergic reaction
• High blood pressure
• Mood changes
• Severe stomach pain, vomiting, or red/black stools
• Seizures
• Fever and chills
• Muscle pain or weakness
• Bone pain
• Skin changes or growths
• Rapid weight gain or swelling in the hands, ankles, or feet
• Blurred vision
• Increased blood sugar

Dr. Takyrbashev says that certain withdrawal symptoms are possible with prednisone as well. “If prednisone is discontinued abruptly, patients might experience withdrawal symptoms, such as fatigue, body aches, and lightheadedness, which can result from a sudden drop in cortisol levels,” he says. “To prevent these withdrawal symptoms, I always recommend a gradual tapering of the dose rather than stopping suddenly. This allows the body to adjust and begin producing cortisol naturally again.” 

Drug interactions

Prednisone may also interact with different medicines. Inform your healthcare provider if you’re taking any of the following medications before beginning prednisone treatment: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
• Diuretics
• Diabetes medications
• Estrogens (birth control pills or hormone replacement therapy)
• Blood thinners
• Macrolide antibiotics, such as azithromycin
• Tuberculosis antibiotics
• Drugs that block cholinesterase (in people with myasthenia gravis)
• Other medications, such as aminoglutethimide, amphotericin B, cholestyramine, cyclosporine, digoxin, digitalis, and isoniazid

Anyone taking prednisone should also avoid drinking alcohol since it may worsen some of the side effects, particularly gastrointestinal ones. It’s also best to avoid getting live vaccines while taking prednisone because it can lower your immune system, which could make vaccines less effective. 

The Cleveland Clinic says that you should also inform your doctor about the presence of other medical problems, including Cushing’s syndrome, diabetes, glaucoma, heart disease, hypertension, kidney or liver disease, mental illness, osteoporosis, seizures, gastrointestinal problems, and thyroid disease. 

Comparing prednisone with other treatments for ear infection

Most ear infections will go away on their own, so treatment options are often the same as other mild illnesses: plenty of rest, fluids, and over-the-counter (OTC) medicines if necessary. 

However, in cases that don’t clear up within a week or cause severe symptoms, doctors may prescribe their patient’s oral antibiotics like penicillin or amoxicillin. These medications target the source of the infection, while prednisone addresses the symptoms, mainly swelling.

Doctors may prescribe antibiotics and corticosteroids together to treat an ear infection quickly. “While antibiotics target the bacterial aspect of the infection, prednisone focuses on managing inflammation,” Dr. Takyrbashev says. “Prednisone can complement antibiotic therapy by providing comprehensive relief of symptoms.” Just know that antibiotic use only works for bacterial infections, not viral infections. Antibiotics may lead to antibiotic resistance, and there’s evidence that it happens fairly frequently with ear infection treatment.

However, it’s often just a matter of managing the discomfort until the infection resolves itself. This might mean NSAIDs like Advil, analgesics like Tylenol, or OTC ear drops, which can help with pain and middle ear inflammation. Like prednisone, these treat the symptoms of the infection rather than addressing the root cause. 

Ear infection home remedies like cold or warm compresses, neck exercises, and ear irrigation may also help. Remember not to stick foreign objects into your ear, as this could damage the ear structure or worsen the infection. 

The bottom line 

Inflammation is one of the biggest culprits of ear infections, and topical or oral steroids like prednisone are very effective at reducing inflammation. So, even though it’s not the most common ear infection medication, prednisone might be a valuable part of a treatment regimen, but that’s up to a healthcare professional. If you’re worried about an ear infection, get an exam from your healthcare provider, and they’ll provide information on the best medication for you.