Inflammatory Diseases of the Middle Ear Medication

  • Author: Nasir Aziz, MD, MA; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 1, 2010
 

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.

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Antibiotics

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.

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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.

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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.

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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).

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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.

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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.

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Contributor Information and Disclosures
Author

Nasir Aziz, MD, MA  Resident Physician, Riverside Regional Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

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 Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Society of Pediatric Otolaryngology, and Association for Research in Otolaryngology

Disclosure: Nothing to disclose.

Specialty Editor Board

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 College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

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

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, 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, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sanjeev Silva, MBBS, MRCS, DLO, to the development and writing of this article.

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