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.
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.
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.
-
Middle ear anatomy.
