Middle Ear, Eustachian Tube, Inflammation/Infection Medication

Updated: Apr 18, 2018
  • Author: Robert B Meek, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Medication

Medication Summary

Antimicrobials are frequently chosen for the treatment of acute otitis media (AOM) and OME.

Topical nasal decongestants, oral decongestants, nasal steroids, and antihistamines can be used to treat ETD.

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Antimicrobials

Class Summary

These agents are used to eradicate middle ear bacteria and prevent mastoiditis in acute otitis media (AOM) and to help speed the resolution of inflammation and effusion in COME.

Amoxicillin (Trimox, Biomox)

DOC for first-line OM in patients not allergic to penicillin. Administered for a total of 7-10 d for AOM.

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

Useful in penicillin-allergic patients. Administered q12h for 10d to treat OM. High incidence of resistance.

Amoxicillin/clavulanate (Augmentin)

Drug combination treats bacteria resistant to beta-lactam antibiotics. Useful in patients who have failed first-line treatment of OM.

Cefuroxime (Ceftin, Kefurox, Zinacef)

Second-line antimicrobial agent for OM. Also for non type I penicillin allergic patients

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Oral decongestants

Class Summary

These agents are used to decrease swelling of eustachian tube and sinus mucosa.

Pseudoephedrine (Actifed, Sudafed, Afrin)

Used in patients with ETD. Not helpful in OME.

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Nasal corticosteroids

Class Summary

These agents are used to decrease perieustachian tube inflammation.

Mometasone (Nasonex)

Nasal spray; may decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation. Demonstrated no mineralocorticoid, androgenic, antiandrogenic, or estrogenic activity in preclinical trials. Decreases rhinovirus-induced up-regulation in respiratory epithelial cells and modulate pretranscriptional mechanisms. Reduces intraepithelial eosinophilia and inflammatory cell infiltration (eg, eosinophils, lymphocytes, monocytes, neutrophils, plasma cells).

Budesonide inhaled (Pulmicort Turbuhaler, Rhinocort)

This nasal steroid is useful in ETD especially in patients who are also diagnosed with allergic rhinitis.

Fluticasone (Flonase, Flovent, Veramyst)

Has extremely potent vasoconstrictive and anti-inflammatory activity. Has a weak hypothalamic-pituitary-adrenocortical axis inhibitory potency when applied topically.

Triamcinolone inhaled (Azmacort, Nasacort AQ)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Ciclesonide (Omnaris)

Corticosteroid nasal spray indicated for allergic rhinitis. Prodrug that is enzymatically hydrolyzed to pharmacologic active metabolite C21-desisobutyryl-ciclesonide following intranasal application. Corticosteroids have a wide range of effects on multiple cell types (eg, mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (eg, histamines, eicosanoids, leukotrienes, cytokines) involved in allergic inflammation. Each spray delivers 50 mcg.

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Anti-inflammatory Agent

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Methylprednisolone (Medrol Dose Pack)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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