In patients with otitis media or sinusitis, antibiotics must be used judiciously. First-line treatment for both uncomplicated acute otitis media and acute sinusitis is amoxicillin. Erythromycin ethylsuccinate and sulfisoxazole or TMP-SMZ may be used in patients who are allergic to penicillin.
What is the first line treatment for otitis media?
What antibiotics are used to treat otitis media?
- Amoxicillin.
- Amoxicillin/clavulanate.
- Erythromycin base/sulfisoxazole.
- Trimethoprim-sulfamethoxazole.
- Cefixime.
- Cefuroxime axetil.
- Cefprozil.
- Cefpodoxime.
When to treat otitis media?
- Notes:
- Although not recommended as first line therapy given unnecessarily broad spectrum of activity, ceftriaxone for 1-3 days is effective for the majority of uncomplicated otitis media.
- Azithromycin has poor activity against Streptococcus pneumoniae and Haemophilus influenzae and is not recommended for otitis media.
How is serous otitis media treated?
- The initial treatment of chronic ear fluid is often with antibiotics. Even serous or clear fluid will often harbor bacteria. ...
- After fluid is present for 3 months in both ears, ear tubes can be considered. ...
- An adenoidectomy has been shown to be effective in the treatment of serous otitis media . ...
What are the differential diagnoses for otitis media?
- Less common or rare causative organisms:
- Mycoplasma pneumoniae – Some patients with lower respiratory tract infection due to M. pneumoniae have concurrent AOM, although the etiologic role of M. ...
- Rare causes include diphtheritic otitis, tuberculous otitis, and otogenous tetanus, and otitis media due to Chlamydia trachomatis.
What can I take for otitis media if allergic to penicillin?
Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections.
What antibiotics treat ear infections without penicillin?
Hydrocortisone (Cortisporin, Otocort, Poly Otic) Oral antibiotics for infections of the middle ear (otitis media), and severe infections of the outer ear. Cephalexin (Keflex) or other cephalosporin antibiotics. Amoxicillin.
How is allergic otitis media treated?
As a result, most patients are treated with decongestants, antihistamines, or nasal corticosteroids despite a lack of high-quality data demonstrating a clear benefit in OME. (See "The common cold in adults: Diagnosis and clinical features", section on 'Acute otitis media' and "Pharmacotherapy of allergic rhinitis".)
Which antibiotic is best for otitis media?
High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin.
Is azithromycin good for ear infection?
Zithromax Z-PAK (azithromycin) and Augmentin (amoxicillin/clavulanate) are antibiotics used to treat bacterial infections sinusitis, pneumonia, ear infections, bronchitis, and other types of infections caused by susceptible bacteria.
Is ciprofloxacin good for ear infection?
Ciprofloxacin is used to treat bacterial ear infections (swimmer's ear or ear canal infections). It works by stopping the growth of bacteria. This medication belongs to a class of drugs called quinolone antibiotics. This medication treats only bacterial ear infections.
What is the best allergy medicine for fluid in ears?
To additionally reduce the feeling of fullness in your ear, talk to your doctor or pharmacist about an antihistamine that includes a decongestant such as:cetirizine plus pseudoephedrine (Zyrtec-D)fexofenadine plus pseudoephedrine (Allegra-D)loratadine plus pseudoephedrine (Claritin-D)
Does Augmentin treat otitis media?
Thus far, only five antibiotics—high-dose amoxicillin (80 mg per kg per day), amoxicillin-clavulanate (Augmentin), cefuroxime (Ceftin), cefprozil (Cefzil) and ceftriaxone (Rocephin)—have demonstrated a modest degree (60 to 80 percent) of clinical efficacy in the treatment of acute otitis media caused by penicillin- ...
Is levofloxacin good for otitis media?
Although it is not approved for use in children, levofloxacin (Levaquin) is effective in children who have persistent or recurrent acute otitis media.
What is the treatment for otitis media?
Otitis media occurs commonly in children, and is usually treated with an antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media. ...
Can penicillin be used for acute otitis media?
In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media.
What is the most common childhood infection for which antibiotics are prescribed?
Otitis media is the most common childhood infection for which antibiotics are prescribed. Nonetheless, there are a number of important questions about the optimal management of acute otitis media (AOM), and opinion is divided within the medical community on a range of fundamental issues. The purpose of this statement is to address several ...
What is tympanocentesis considered for?
A tympanocentesis should be considered for both therapeutic (relief of pressure and pain) and for diagnostic (recovery of the etiologic agent) purposes. If a tympanocentesis is not practical, consideration should be given to adding amoxicillin-clavulanate or selecting one of the alternative agents from Table 1.
Is penicillin more expensive than amoxicillin?
Furthermore, the newer, broader spectrum, penicillinase-stable antimicrobial agents are substantially more expensive than amoxicillin (Table 1), and their use may be associated with relatively high rates of side effects and may increase the pressure for selection of multiply antibiotic-resistant strains of bacteria.
Is parenteral therapy better than oral therapy?
There is, at present, little published evidence that parenteral therapy provides any advantage to the conventional 10-day oral therapy. Furthermore, the use of such broad-spectrum agents may hasten the emergence of antibiotic-resistant organisms.
Is antimicrobial therapy necessary for AOM?
Antimicrobial therapy is one of the cornerstones in the management of AOM but some studies have suggested that its routine use is not indicated (2–4). Because the majority of cases of AOM resolve spontaneously (1), it might appear that antimicrobial therapy is not necessary.
What happens if you take penicillin with a skin test?
A positive reaction to a test will cause a red, itchy, raised bump.
What is the treatment for anaphylaxis?
Treatment of anaphylaxis. Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing.
What does a negative penicillin test mean?
A negative test result usually means you're not at high risk of an allergy to penicillin. But a negative result is more difficult to interpret because some kinds of drug reactions cannot be detected by skin tests.
Can penicillin be misdiagnosed?
A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. Your doctor will conduct a physical examination, ask questions about your symptoms and order additional tests. You may be referred to an allergy specialist (allergist) for these tests. These may include the following.
Can you repeat penicillin treatment?
If you need penicillin in the future, you will need to repeat the desensitization treatment. You're carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.
Can you take penicillin if you are allergic to it?
You will be able to take the drug as prescribed. If you are allergic to one type of penicillin, your doctor may recommend a graded challenge with a type of penicillin or cephalosporin that's less likely — because of known chemical properties — to cause an allergic reaction.
First-Line Recommendations
The first consideration here, appropriate antibiotics for an ear infection, is the type of ear infection you have (e.g. middle ear infection, external ear infection, etc...) as treatment choice depends on this.
Penicillin Allergy Alternative Antibiotics
With penicillin and penicillin-type antibiotics (like amoxicillin) off the table, there are several other options you and your doctor can consider.
What About Ear Drops?
There are several antibiotics available in a topical 'eardrop' form, and many of these antibiotics are combined with steroids for pain relief. These drug options include:
Cross-Reactivity with Cephalosporins
Penicillin and cephalosporins both contain a ß-lactam ring. This structural similarity has led to considerable confusion regarding cross-reactivity of these drugs and the risks for allergic reactions from cephalosporins among penicillin-allergic patients.
Validating Penicillin or Another ß-Lactam Antibiotic Allergy
Evaluating a patient who reports a penicillin or another ß-lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other ß-lactam antibiotics ( 658 ); 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated ß-lactam therapy ( 667, 675 )..
Skin Testing for Penicillin Allergy
Skin testing for penicillin allergy should be performed if any indication exists that the symptoms were secondary to an IgE-mediated hypersensitivity. Testing is also indicated as a potential diagnostic procedure to definitively rule out penicillin allergy and document a negative allergy status in the medical record (i.e., delabeling).
What is the mainstay of treatment for acute otitis media?
Antibiotics are the mainstay of treatment of uncomplicated acute otitis media (AOM) in adults, and initial antibiotic choice is determined by knowledge of the most common causative pathogens. (See 'Microbiology' above.)
How long does it take for antibiotics to work for otitis?
For patients treated medically and for those requiring surgery, prolonged antibiotics (eg, six weeks ) are indicated. Otitic meningitis — Otitic meningitis is the most common intracranial complication of chronic otitis and mastoiditis, although meningitis may also occur in association with AOM as well.
What is AOM in ear?
● Definition and overview – Acute otitis media (AOM) is an acute, suppurative infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the middle ear space ( picture 1 ). The infection is most frequently precipitated by impaired function of the Eustachian tube, resulting in the retention and suppuration of retained secretions ( figure 1 ). AOM may also be associated with purulent otorrhea if there is a ruptured tympanic membrane. AOM usually responds promptly to antimicrobial therapy. (See 'Definition' above.)
What are the complications of acute otitis media?
Other complications following an episode of acute otitis media (AOM) in adults are rare but can occur due to a variety of factors, such as impaired immune status, abnormal anatomy, inadequate antibiotic treatment, or a particularly virulent pathogen.
What is the second generation of cephalosporin?
Second- or third-generation cephalosporins are alternative agents in patients with mild penicillin allergy or who are known to tolerate cephalosporins. Alternatives in patients who are highly penicillin-allergic and/or allergic to cephalosporins include doxycycline. (See 'Treatment of acute otitis media' above.)
Is there a guideline for antibiotics for AOM?
There are no society guideline recommendations regarding antibiotic choice in the treatment of AOM in adults, although there are recommendations for adolescents. Additionally, there are society recommendations for antibiotic choice in the treatment of acute bacterial sinusitis in adults, an infection with similar microbiology to AOM [ 46 ].
