Q: My 7-year-old has pus in both ears and a high fever after changing antibiotics. Should we go to a larger hospital right away?

Medically reviewed by Sang Hyun Ahn, MD

Content edited by Myeongchan Kim, MD

This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Question:

Hello, my 7-year-old son has had a runny nose and cold symptoms for about 15 days. He took antibiotics for 10 days, but the runny nose didn't stop. On Saturday, we visited an ENT clinic, and they found pus in one of his ears. They changed his antibiotics, but from that evening until dawn, he developed a fever between 38°C and 39°C. We went back to the clinic this morning, and they found pus in the other ear as well. They changed his prescription again to Cefpodoxime proxetil dry syrup.

The doctor told us to go to a larger hospital if there is no improvement with this new medication. However, my child's overall condition and energy levels are not bad. He also tested negative for the flu today.

My questions are: Should we just give him the new antibiotics and wait, or should we go to a children's hospital for further testing right now? Also, can an ear infection cause this kind of fever? Lastly, is it okay to suction his nose? I was told absolutely not to do sinus rinses, but would it be okay to use a nasal spray and then suction the mucus? Thank you in advance.

Answer:

Hello. I understand how worrying it must be to see your son struggling with prolonged cold symptoms and bilateral ear infections (otitis media) for the past two weeks.

First, regarding your concern about his temperature: a combination of bilateral ear infections and a fever is a very common presentation. Otitis media can certainly cause a high fever of 38°C to 39°C. The fact that your child's overall condition and energy levels are still good is a very positive sign.

Based on his current condition, here is what you can do at this stage:

1. Observe with the new antibiotics: It is generally recommended to evaluate the effectiveness of a new antibiotic after 48 to 72 hours of use. Cefpodoxime is an effective second-line antibiotic for treating ear infections. Since his overall condition is good, you can administer this new medication and monitor him at home before heading to a larger hospital.

2. Fever Management: Keep him comfortable by using over-the-counter fever reducers (such as Acetaminophen or Ibuprofen, which can be alternated if needed).

3. Nasal Management: You were advised correctly—nasal or sinus rinsing (flushing with large volumes of water) should be avoided when there is an active ear infection. However, using a saline nasal spray followed by gently blowing or suctioning the nose is perfectly fine. Additionally, using a humidifier and encouraging him to drink plenty of warm water will help thin the mucus.

When to visit a larger hospital immediately:

Please seek immediate medical evaluation if you observe any of the following red flags:

• The fever persists for more than 48 hours after starting the new antibiotics.

• His ear pain significantly worsens, or you notice fluid/discharge draining from the ears.

• He becomes lethargic, overly drowsy, or refuses to eat/drink.

• He complains of a stiff neck or a severe headache.

In most cases, children improve within 2 to 3 days once they are on the appropriate antibiotics. Please make sure to administer the medication exactly as directed by your doctor until the course is completely finished. Ensure he gets plenty of rest and hydration, and follow up with your doctor in 48 hours for a re-evaluation of his ears and fever.

For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.

fevercoach.us

Apple App Store

Google Play

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