treatment of otitis externa for patient who is allergic to amoxicillin

High-dosage amoxicillin

(80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. Patients who do not respond to treatment should be reassessed.

Full Answer

How to treat otitis media?

 · Pain is a common symptom of acute otitis externa, and can be debilitating. 12 Oral analgesics are the preferred treatment. First-line analgesics include nonsteroidal anti-inflammatory drugs and...

How to treat serous otitis media?

Patients who may have developed allergic otitis externa should undergo patch testing. Otolaryngologists should consider using topical antibiotics with a low allergenic potential and …

Does doxycycline treat otitis media?

 · The preferred antibiotic for AOM is amoxicillin, with amoxicillin/clavulanate reserved for specific circumstances. Prescription of antibiotics is not recommended for the …

Can otitis media be treated without antibiotics?

Abstract. 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 …

What antibiotics treat ear infections if allergic to amoxicillin?

High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections.

What is the best antibiotic for otitis externa?

Topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones are the treatment of choice in uncomplicated cases. These agents come in preparations with or without topical corticosteroids; the addition of corticosteroids may help resolve symptoms more quickly.

What antibiotics treat ear infections without penicillin?

Oral antibiotics for infections of the middle ear (otitis media), and severe infections of the outer ear. Cephalexin (Keflex) or other cephalosporin antibiotics. Amoxicillin. Amoxicillin/clavulanate (Augmentin)

What oral antibiotics treat otitis externa?

Ciprofloxacin, is a drug of choice for treating severe otitis externa. Due to its better absorption, wide distribution, and broad spectrum of activity against gram negative and gram positive pathogens, severe infections can be treated orally.

Can azithromycin treat otitis externa?

In the amoxicillin/clavulanate trial, compliance with single dose azithromycin was significantly better than with the amoxicillin/clavulanate regimen (P < 0.001). We conclude that a single dose of azithromycin (30 mg/kg) is safe and effective for the treatment of uncomplicated AOM in children.

What is the best ear drops for otitis externa?

Ciprofloxacin and dexamethasone combination ear drops is used to treat ear infections, such as acute otitis externa and acute otitis media. Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal caused by bacteria.

Can doxycycline be used for ear infection?

Doxycycline may be prescribed for bacterial ear infections or earaches resulting from a sinus infection.

Is Cipro 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.

Is clindamycin good for ear infection?

Clindamycin is also sometimes used to treat ear infections, tonsillitis (infection that causes swelling of the tonsils), pharyngitis (infection that causes swelling in the back of the throat), and toxoplasmosis (an infection that may cause serious problems in people who do not have healthy immune systems or in unborn ...

What are drugs applied to the external ear canal?

Commonly used topical eardrops are acetic acid drops, which change the pH of the ear canal; antibacterial drops, which control bacterial growth; and antifungal preparations. Oral or parenteral antibiotics are reserved for severe cases.

How do you treat otitis externa?

Treatments your GP can provideantibiotic ear drops – this can treat an underlying bacterial infection.corticosteroid ear drops – this can help to reduce swelling.antifungal ear drops – this can treat an underlying fungal infection.acidic ear drops – this can help kill bacteria.

Is Keflex good for otitis externa?

Oral preparations of cephalosporins are often prescribed for the treatment of otitis media in children. These drugs are usually recommended after failure of therapy with other antibiotics. However, many practitioners began treatment of otitis with cefaclor (Ceclor) or cephalexin monohydrate (Keflex).

How long does antibiotic therapy last for otitis media?

Children six to 23 months of age with bilateral acute otitis media without severe signs or symptoms: antibiotic therapy for 10 days. Children six to 23 months of age with unilateral acute otitis media without severe signs or symptoms: observation or antibiotic therapy for 10 days.

How long does it take to treat unilateral otitis media?

Children six to 23 months of age with unilateral acute otitis media without severe signs or symptoms: observation or antibiotic therapy for 10 days

What is the diagnosis of AOM?

An AOM diagnosis requires moderate to severe bulging of the tympanic membrane, new onset of otorrhea not caused by otitis externa, or mild bulging of the tympanic membrane associated with recent onset of ear pain (less than 48 hours) or erythema. C.

How many children have otitis media?

Otitis media is among the most common issues faced by physicians caring for children. Approximately 80% of children will have at least one episode of acute otitis media (AOM), and between 80% and 90% will have at least one episode of otitis media with effusion (OME) before school age. 1, 2 This review of diagnosis and treatment ...

What is otitis media with effusion?

Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.

How long does it take for otitis media to show up in children?

Children two years or older without severe signs or symptoms: observation or antibiotic therapy for five to seven days. Persistent symptoms (48 to 72 hours) Repeat ear examination for signs of otitis media. If otitis media is present, initiate or change antibiotic therapy.

What is AOM in a complication?

Special Populations. References. Usually, AOM is a complication of eustachian tube dysfunction that occurred during an acute viral upper respiratory tract infection. Bacteria can be isolated from middle ear fluid cultures in 50% to 90% of cases of AOM and OME.

What is the first line of treatment for acute otitis externa?

Topical antimicrobial otic preparations should be considered the first-line treatment foruncomplicated acute otitis externa.

What is the treatment for diffuse otitis externa?

Consider treatment with heat, incision and drainage, or systemic antibiotics; can progress to diffuse otitis externa

What are the factors that predispose otitis externa?

4, 10 One of the most common predisposing factors is swimming, especially in fresh water. Other factors include skin conditions such as eczema and seborrhea, trauma from cerumen removal, use of external devices such as hearing aids, and cerumen buildup. 4 These factors appear to work primarily through loss of the protective cerumen barrier, disruption of the epithelium (including maceration from water retention), inoculation with bacteria, and increase in the pH of the ear canal. 10 – 12

What is the temperature of otitis externa?

Pain is the symptom that best correlates with the severity of disease. 13 Mild fever may be present, but a temperature greater than 101°F (38.3°C) suggests extension beyond the auditory canal.

What are the two most common isolates of otitis externa?

4 The two most common isolates are Pseudomonas aeruginosa and Staphylococcus aureus.

What is otitis externa?

Follow-up and Referral. References. Acute otitis externa is a common condition involving inflammation of the ear canal. The acute form is caused primarily by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus the most common pathogens. Acute otitis externa presents with the rapid onset of ear canal inflammation, ...

What is the ear infection called?

Otitis externa, also called swimmer's ear, involves diffuse inflammation of the external ear canal that may extend distally to the pinna and proximally to the tympanic membrane. The acute form has an annual incidence of approximately 1 percent 1 and a lifetime prevalence of 10 percent. 2 On rare occasions, the infection invades ...

What is the treatment for otitis externa?

Chronic otitis externa is a common condition, which is usually successfully treated by topical medications and aural toilet. In cases that persist despite conventional treatment, a diagnosis of allergic otitis externa should be considered. Sensitization to otic medications (secondary contact otitis) is not uncommon. Topical aminoglycosides are the most common sensitizers although many components of topical preparations can cause sensitization. Patients who may have developed allergic otitis externa should undergo patch testing. Otolaryngologists should consider using topical antibiotics with a low allergenic potential and avoiding neomycin when treating patients with otitis externa. Primary contact otitis may occur to metals used in earrings and also to hearing aid moulds. Treatment of both primary and secondary contact otitis consists of identifying the allergen, avoiding further contact and use of simple preparations avoiding common sensitizers.

Is otitis externa a common condition?

Allergic otitis externa. Chronic otitis externa is a common condition, which is usually successfully treated by topical medications and aural toilet. In cases that persist despite conventional treatment, a diagnosis of allergic otitis externa should be considered.

Can otitis externa be a secondary contact?

Sensitization to otic medications (secondary contact otitis) is not uncommon. Topical aminoglycosides are the most common sensitizers although many components of topical preparations can cause sensitization. Patients who may have developed allergic otitis externa should undergo patch testing.

Can otolaryngologists use antibiotics for otitis externa?

Otolaryngologists should consider using topical antibiotics with a low allergenic potential and avoiding neomycin when treating patients with otitis externa. Primary contact otitis may occur to metals used in earrings and also to hearing aid moulds.

What is the best antibiotic for otitis media?

1, 22. Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media. B. 1. Patients with otitis media who fail to respond to the initial treatment option within 48 to 72 hours should be reassessed to confirm the diagnosis.

What are the symptoms of acute otitis media?

1 Nonspecific symptoms of acute otitis media (e.g., fever, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, pulling at the ears) are common in infants and young children. Otalgia is less common in children younger than two years and more common in adolescents and adults. 4 Acute otitis media cannot be reliably differentiated from upper respiratory tract infection on the basis of symptoms alone. 10 However, otalgia, ear rubbing or pulling, and parental suspicion of otitis media have positive likelihood ratios (LR+) of 3.0 or more and are moderately useful for ruling in the diagnosis ( Table 4 12 – 16 ). 12, 13

What is suppurative otitis media?

Chronic suppurative otitis media presents with persistent or recurrent otorrhea through a perforated tympanic membrane (active), or with a dry but permanent perforation of the tympanic membrane (inactive). 6 Other features include thickened granular mucosa, polyps, and cholesteatoma in the middle ear. 18 Aerobic and anaerobic bacteria may enter the middle ear through the perforation. 6 Rarely, Pseudomonas species may cause deep-seated destructive infections of the middle ear and the mastoid cavity. Diagnosis is made by history and examination, including otoscopy. Examination may detect other foci of infection requiring treatment (e.g., nose, paranasal sinuses, lungs, pharynx). Careful cleaning of the ear is useful for visualizing the tympanic membrane and the attic, and for excluding cholesteatoma. 19

How to detect middle ear effusion?

Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of acute otitis media. The tympanic membrane normally is convex, mobile, translucent, and intact; a normal color and mobility of the membrane indicate that otitis media is unlikely (negative likelihood ratio [LR–], 0.03). 10 A bulging membrane greatly increases the likelihood of otitis media (LR+, 20.3), as do impaired mobility of the membrane (LR+, 4.7) and a distinctly red membrane (LR+, 2.6), albeit to a lesser extent. 14

What is the risk factor for persistent ear effusion?

Risk factors for persistent acute otitis media with effusion include hearing loss greater than 30 dB, prior tympanostomy tube placement, adenoid hypertrophy, and onset during summer or fall. 34

How many doses of ceftin for otitis media?

Cefuroxime (Ceftin) 30 mg per kg per day, given orally in two divided doses.

How long does it take for otitis media to resolve?

20 Most children with acute otitis media (70 to 90 percent) have spontaneous resolution within seven to 14 days; therefore, antibiotics should not routinely be prescribed initially for all children. 21, 22 Delaying antibiotic therapy in selected patients reduces treatment-related costs and side effects and minimizes emergence of resistant strains. 23

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.

Can antibiotics treat 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. As he had previously experienced a rash after the administration of a penicillin, the medication order was switched from amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine whether or not this intervention was appropriate, references were found using Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues to be addressed included the need for antibiotics in acute otitis media, the comparative efficacy and tolerability of antimicrobial agents and the reliability of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be first-line agents in the treatment of acute otitis media owing to their efficacy, safety and cost, with neither drug being significantly better than the other. The need to treat otitis media with antibiotics remains controversial. Reported penicillin allergies were found to be an unreliable indicator of a potentially serious reaction. In conclusion, it was found that treatment with TMP/SMX was an appropriate intervention.

How to treat acute otitis externa?

The treatment of uncomplicated acute otitis externa consists of cleansing the ear canal, topical antiseptic and antimicrobial treatment, and adequate analgesia. Primary oral antibiotic treatment should be given only if the infection has spread beyond the ear canal, in the setting of poorly controlled diabetes mellitus or immunosuppression, or if topical treatment is not possible (10) (figure 2). The DEGAM, in its guideline on ear pain, accordingly recommends cleansing the ear canal and using local antibiotics and/or corticosteroids as indicated, in consideration of their availability, costs, and risks. Systemic antibiotic treatment should be considered in individual cases if there are systemic manifestations, or whenever problematic organisms are found (1).

What is the treatment for otitis media?

The treatment of acute otitis media consists of analgesia, cleansing of the external auditory canal, and the application of antiseptic and antimicrobial agents. Local antibiotic and corticosteroid preparations have been found useful, but there have been no large-scale randomized controlled trials of their use. Topical antimicrobial treatments lead to a higher cure rate than placebo, and corticosteroid preparations lessen swelling, erythema, and secretions. Oral antibiotics are indicated if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immunosuppression. Chronic otitis externa is often due to an underlying skin disease. Malignant otitis externa, a destructive infection of the external auditory canal in which there is also osteomyelitis of the petrous bone, arises mainly in elderly diabetic or immunosuppressed patients and can be life-threatening.

What is malignant otitis externa?

Malignant (necrotizing) otitis externa is a destructive infection of the external auditory canal with invasive perichondritis and osteomyelitis of the lateral skull base, arising mainly in elderly men who are either diabetic or immunosuppressed .

What is the abscess in the hair follicle?

Chronic otitis externa often fails to respond to treatment administered for several weeks. Circumscribed otitis externa. Circumscribed otitis externa is an abscess-forming infection of a hair follicle (i.e., a furuncle) in the cartilaginous part of the external auditory canal, mostly due to Staphylococcus aureus.

What is the pain in the ear?

The characteristic symptom of acute otitis externa is severe pain in the ear (otalgia) due to irritation of the periosteum just under the thin dermis of the bony ear canal, which has no subcutis. The pain is typically worsened by pressure on the tragus or tension on the pinna. Further symptoms are otorrhea, itch, erythema, and swelling of the ear canal, potentially leading to conductive hearing loss.

What is the term for an infection of the cutis and subcutis of the external auditory canal?

Otitis externa is defined as an infection of the cutis and subcutis of the external auditory canal, possibly involving the tympanic membrane and the pinna as well.

What is otitis externa?

Otitis externa is one of the more common diseases in otorhinolaryngological practice and is also frequently encountered in primary and pediatric care. It ranges in severity from a mild infection of the external auditory canal to life-threatening malignant otitis externa. Its correct treatment requires a good understanding of the anatomy, physiology, and microbiology of the ear canal. No German guidelines deal specifically with otitis externa; it is briefly discussed in the AWMF-S2k guidelines on ear pain of the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin,DEGAM) (1). Here we discuss the epidemiology, etiology, and treatment of otitis externa in the light of the current scientific evidence.

What antibiotics are used for otitis externa?

The frequent use of Amoxicillin and Co-amoxiclav (amoxicillin/clavulanic acid) identified in our review was concerning as the causative bacteria in AOE are predominantly Pseudomonas aeruginosa and Staphylococcus aureus [8], and these antibiotics are inactive against these pathogens. Ciprofloxacin and Flucloxacillin are better choices when indicated. A UK study of general practice electronic healthcare records of 72,278 patients with a diagnosis of otitis externa between 2010 and 2015 found that the rate of inappropriate choice of oral antibiotics was high at 67% [19].  They also found that the most commonly prescribed inappropriate antibiotic was Amoxicillin [19]. The findings of this study and our results indicate that the inappropriate selection of oral antibiotics in AOE appears to be a highly prevalent problem in primary care in the United Kingdom. Not only ineffective, this practice may also lead to avoidable adverse drug events, non-compliance, antibiotic resistance, and the associated healthcare costs [5,8]. Topical antibiotics do not typically suffer with these problems [8]. The high local concentration of topical antibiotics far exceeds the minimum inhibitory concentrations needed to eradicate even resistant organisms [8]. This may explain the equivalent efficacy of various topical preparations demonstrated in meta-analyses [4,5].

How many patients are prescribed antibiotics in ENT?

Of the hospital-based studies, Pabla et al. [13] found that GPs prescribed oral antibiotics in 16% of patients that had attended their ENT emergency clinic. Trinidade et al. [14] showed a similar rate of 17%, often with Co-amoxiclav (amoxicillin/clavulanic acid), followed by Amoxicillin and Erythromycin.

What is the prevalence of oral antibiotics?

Oral antibiotics: The prevalence of prescriptions for oral antibiotics as monotherapy was 6%-30% in patients treated in primary care . A narrower primary care prescription rate of 16%-17% was observed in patients attending the ENT emergency clinic. When oral antibiotics were prescribed, Amoxicillin and Co-amoxiclav (amoxicillin/clavulanic acid) were consistently chosen by GPs to treat otitis externa. The use of oral antibiotics as monotherapy may be an estimate of the rate of cases of otitis externa that were suboptimally managed as the inferred omission of topical antibiotics highlights a potential unawareness among prescribers that topical therapy is the mainstay of treatment. The Thailand study by Greer et al. [16] found an oral antibiotic prescription rate of 80%; however, this was considered an outlier as described below. Trinidade et al. [14] suggested that the rate of unnecessary oral antibiotics, which were defined as lacking a valid indication, may be as high as 86% according to their dataset. However, this finding should be treated with caution, also discussed below.

What are the primary outcomes of antibiotics?

The primary outcome measures were the rates of topical, oral, or a combination of antibiotic prescriptions for uncomplicated acute otitis externa (AOE) in primary care . The secondary outcome measures included the choice of prescribed antibiotics and the rate of oral antibiotic prescriptions without a valid indication.

What is AOE in general practice?

Acute otitis externa (AOE) is a common problem for general practitioners (GPs) [1] and is one of the top 10 reasons for antibiotic prescriptions in general practice [2]. It is also the condition most frequently referred to the ear, nose, and throat (ENT) emergency clinic [3]. The most effective treatment for uncomplicated AOE is topical antibiotics, achieving clinical cure rates of up to 80% within 10 days of therapy [4]. Two meta-analyses [4,5] have concluded that the choice of topical antimicrobial is not important as the impact of different preparations on the rates of clinical and bacteriologic cure is minimal. Oral antibiotics, however, are associated with disease persistence and recurrence in mild cases [1] and are therefore a poor choice for initial therapy.

What is the most common antibiotic prescribed?

The most frequent prescriptions were Amoxicillin or Ampicillin (34%), followed by Co-amoxiclav (amoxicillin/clavulanic acid) (19%), Flucloxacillin (15%), and macrolides (14%) [1]. Selwyn and Lau [11] found that 6% of patients were given only an oral antibiotic, usually Amoxicillin (11%).

What is the rate of combination therapy with topical and oral antibiotics?

Rowlands et al. [1] found that the rate of combination therapy with topical and oral antibiotics was 15% . Selwyn and Lau [11] identified a similar rate of 16%. Pabla et al. [13] and Trinidade et al. [14] found that the rate was higher at 28% and 33%, respectively.

What is AOM in ear?

For the purpose of this paper, AOM is defined as the sudden onset of inflammation of the middle ear associated with an effusion and one or more of the following: pain, fever and irritability. The diagnosis must be established by careful examination with pneumatic otoscopy.

What are the most common etiological agents for AOM?

Bacteria cause the majority of cases of AOM, and the most frequent etiological agents are Streptococcus pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus and Staphylococcus aureus. Viruses continue to cause a substantial minority of cases (7), and antibiotic therapy would not be expected to affect the outcome. With the increasing prevalence of beta-lactamase-producing (penicillin-resistant) strains of H influenzaeand M catarrhalis, alarms have been sounded about the wisdom of routinely using aminopenicillins (such as amoxicillin) as the standard first-line antimicrobial for uncomplicated AOM. Despite theoretical concerns about the diminishing usefulness of amoxicillin, it continues to be as effective as any other oral antimicrobial agent for childhood AOM. In fact, it works as well as extended spectrum, penicillinase-resistant oral agents for otitis media caused by either penicillin-susceptible or -resistant bacteria (1). Most comparative trials of antimicrobial therapy in AOM have failed to demonstrate a difference in effectiveness between amoxicillin and any other agent. 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. Therefore, because of its excellent ‘track record’ (for infections due to penicillin-susceptible and -resistant bacteria), low cost, safety and acceptability to patients, amoxicillin remains the drug of choice for uncomplicated AOM.

Why is it difficult to interpret AOM?

Evaluation of studies to determine whether antibiotic therapy influences the outcome of AOM has been difficult to interpret because of the high spontaneous recovery rate in children with the disease (1). Furthermore, many of the studies have been designed to try to demonstrate whether new antimicrobial agents are as good as conventional therapy, but they have employed small sample sizes. For a disease with a high spontaneous rate of improvement, only studies with a very large sample size provide enough power to demonstrate whether two different interventions are indeed truly comparable. Thus, the published literature provides little guidance regarding superiority of one antimicrobial agent over another.

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.

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 ...

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.

Can you use parenteral therapy for AOM?

Furthermore, the use of such broad-spectrum agents may hasten the emergence of antibiotic-resistant organisms. Except in extraordinary situations, parenteral therapy should not be employed for simple uncomplicated childhood AOM. If a child appears to be too ill to comply with standard oral therapy, a diagnosis other than AOM should be entertained and admission to hospital should be considered.