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Inflammatory Diseases of the Middle Ear Medication

  • Author: Diego A Preciado, MD, PhD, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
Updated: Feb 08, 2016

Medication Summary

The aim of medical treatment in uncomplicated cases of AOM and CSOM is to eliminate infection and to control otorrhea. The main medical therapies include various antibiotics and topical medications. Topical agents include a combination of antibiotics, antiseptics, solvents, and steroids.



Class Summary

S pneumoniae, H influenzae, and M catarrhalis cause most episodes of AOM. These organisms are known to be sensitive to amoxicillin and ampicillin. Although a short course of topical aminoglycoside through a perforated eardrum and an infected middle ear can be used, these are not FDA approved for middle ear usage, and prolonged use is certainly not recommended because of possible ototoxic effects. Only fluoroquinolones, specifically ofloxacin, are approved for middle ear usage in draining AOM.

Amoxicillin (Amoxil)


Derivative of ampicillin and has similar antibacterial spectrum, namely certain gram-positive and gram-negative organisms. Better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations.

Erythromycin (E-Mycin, Ery-Tab)


Has an antibacterial spectrum similar but not identical to that of penicillin; alternative for patients who are allergic to penicillin.

Penicillin G benzathine (Bicillin L-A)


Remains an important and useful antibiotic but is inactivated by bacterial beta-lactamases. Parenteral therapy with benzylpenicillin is used initially in severe infections, followed by 3-7 days of oral phenoxymethylpenicillin (penicillin V).

Gentamicin with hydrocortisone (Jenamicin, Garamycin)


Aminoglycosides although commonly used topical antibiotics, controversy surrounds topical therapy because of its potential for ototoxicity. Literature contains sporadic reports of sensorineural hearing loss associated with their use. Medication must be compounded at pharmacy.

Ciprofloxacin otic (Ciloxan)


Quinolone derivatives, such as ciprofloxacin and ofloxacin, have excellent antipseudomonal activity. Fluoroquinolone with activity against Pseudomonas and Streptococcus species, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, and most gram-negative organisms; no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Also available as ototopical preparations, with little demonstrable systemic effects. Approved for ophthalmic use but used ototopically off-label.

Contributor Information and Disclosures

Diego A Preciado, MD, PhD, FAAP Assistant Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, George Washington University School of Medicine, Children's National Medical Center

Diego A Preciado, MD, PhD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Association for Research in Otolaryngology, American Society of Pediatric Otolaryngology, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Vesticon<br/>Received none from Vesticon, Inc. for board membership.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, American College of Surgeons, American Medical Association, American Tinnitus Association, Florida Medical Association, North American Skull Base Society

Disclosure: Received consulting fee from Synthes Power Tools for consulting.


The authors and editors of Medscape Drugs & Diseases gratefully acknowledge previous authors Nasir Aziz, MD, MA, Resident Physician, Riverside Regional Medical Center, and Sanjeev Silva, MBBS, MRCS, DLO, Senior House Officer, Department of Otorhinolaryngology, Head and Neck, Facial Plastics, Great Ormond Street Hospital for Sick Children, UK, for their contributions to this article.

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Middle ear anatomy.
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