Otitis media and otitis externa are among the most frequently encountered ear infections in clinical practice, particularly affecting children and individuals exposed to humid environments or water. Despite differing in anatomical site and causative organisms, both conditions require prompt and tailored pharmacological intervention to alleviate symptoms, resolve infection, and prevent complications. Acute otitis media (AOM) is primarily managed with analgesics and selective antibiotic use, following evidence-based guidelines that emphasize judicious antimicrobial therapy to reduce resistance. Otitis media with effusion (OME) and recurrent AOM often necessitate non-pharmacological strategies, including tympanostomy tubes, rather than routine antibiotics. In contrast, otitis externa is best treated with topical antimicrobials—particularly fluoroquinolone-steroid combinations—with systemic antibiotics reserved for severe or necrotizing cases. This review synthesizes the current evidence on the pharmacological approaches to otitis media and externa, emphasizing pathogen-specific treatment, age-based recommendations, and antibiotic stewardship