Treatments for Middle ear infection
Treatments for Middle ear infection
The list of treatments mentioned in various sources
for Middle ear infection
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Middle ear infection: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Middle ear infection may include:
Hidden causes of Middle ear infection may be incorrectly diagnosed:
Middle ear infection: Research Doctors & Specialists
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Middle ear infection:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Middle ear infection include:
- Ceftriaxone
- Rocephin
- Dexamethasone
- Macrolide antibiotics
- Azithromycin
- Zithromax
- Clarithromycin
- Biaxin
- Biaxin XL
- Biaxin XL Pac
- Erythromycin
- Apo-Erythro Base
- Apo-Erythro E-C
- Apo-Erytrho-ES
- Apo-Erythro-S
- E.E.S
- E.E.S. 200
- E.E.S. 400
- E-Mycin Controlled Release
- E-MycinE
- E-Mycin 333
- Eramycin
- Erybid
- ERYC
- EryPed
- Eryphar
- Ery-Tab
- Erythrocin
- Erythromid
- Ethril
- ETS-2%
- Ilosone
- Ilotycin
- Novo-Rythro
- PCE
- Pediamycin
- Pediazole
- PMS-Erythromycin
- Robimycin
- SK-Erythromycin
- Wyamycin E
- Wyamycin S
- Amoxicillin
- A-Cillin
- Amoxil
- Apo-Amoxi
- Clavulin
- Larotid
- Novamoxin
- Nu-Amoxi
- Polymox
- Prevpac
- Trimox
- Wymox
- Amoxicillin/Clavulanate
- Amcill
- Ampicillin
- Ampicin
- Ampicin PRB
- Ampilean
- Apo-Ampi
- Augmentin
- D-Amp
- Faspak Ampicillin
- 500 Kit
- Novo-Ampicillin
- Nu Ampi
- Omnipen
- Omnipen Pediatric Drops
- Pardec Capsules
- Penbritin
- Polycillin
- Polycillin Pediatric Drops
- Polycillin-PRB
- Pondocillin
- Principen
- SK-Ampicillin
- Totacillin
- Bacampicillin
- Penglobe
- Spectrobid
- Cloxacillin
- Apo-Cloxi
- Bactopen
- Cloxapen
- Novo-Cloxin
- Nu-Cloxi
- Orbenin
- Tegopen
- Penicillin VK
- Apo-Pen-VK
- Beepen VK
- Betapen-VK
- Ledercillin VK
- Nadopen-V
- Novopen-VK
- Nu-Pen-VK
- Penapar VK
- Pen-V
- Pen-Vee K
- Pfizerpen VK
- PVF
- PVF K
- Robicillin VK
- SK-Penicillin VK
- Uticillin VK
- V-Cillin K
- VC-K 500
- Veetids
- Win-Cillin
- DisperMox
- Utimox
- Amoxifur
- Pro-Amox
- Moxilin
- Gen-Amoxicillin
- Lin-Amox
- PMS-Amoxicillin
- Nandrolone
- Acroxil
- Amobay
- Amoxinovag
- Amoxisol
- Amoxivet
- Ampliron
- Ardine
- Flemoxon
- Gimalxina
- Grunicina
- Hidramox
- Moxlin
- Penamox
- Servamox
- Solciclina
- Xalyn-Or
- Amoxicillin and Clavulanate Potassium
- Augmentin ES-600
- Augmentin XR
- Alti-Amoxi-Clav
- Apo-Amoxi-Clav
- Eumetinex
- Ceclor CD
- Raniclor
- Apo-Cefaclor
- Novo-Cefaclor
- Nu-Cefaclor
- PMS-Cefaclor
- Cefol
- Kefzol
- Procef
- Ceftibuten
- Cedax
- Amcel
- Benaxona
- Cefaxona
- Ceftrex
- Tacex
- Terbac
- Triaken
- Cephalexin
- Biocef
- Panixine DisperDose
- Apo-Cephalex
- Naxifelar
- Oxymetazoline
- Afrin
- Afrin Extra Moisturizing
- Duramist Plus
- Duration
- Genasal
- Neo-Synephrine 12 Hour
- Neo-Synephrine 12 Hour Extra moisturizing
- Nostrilla
- Twice-A-Day
- Vicks Sinex 12 Hour Ultrafine Mist
- Visine L.R
- 4-Way Long Acting
- Claritin Allergic Decongestant
- Dristan Long Lasting Nasal
- Drixoral Nasal
- Liadin
- Ocuclear
- Oxylin
- Visine A.D
- Penicillin V Potassium
Latest treatments for Middle ear infection:
The following are some of the latest treatments for Middle ear infection:
Hospital statistics for Middle ear infection:
These medical statistics relate to hospitals, hospitalization and Middle ear infection:
- 0.262% (33,436) of hospital consultant episodes were for nonsuppurative otitis media in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 100% of hospital consultant episodes for nonsuppurative otitis media required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 57% of hospital consultant episodes for nonsuppurative otitis media were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 43% of hospital consultant episodes for nonsuppurative otitis media were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
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Book Excerpts: Treatment of Middle ear infection
Treatments of Middle ear infection: Online Medical Books
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for more information about the treatments of Middle ear infection.
Otorrhea:
Treatment
(In a Page: Signs and Symptoms)
-
Otitis externa is treated with antibiotic drops; alternatively, acidification of the ear canal with acetic acid is also effective; patients should follow water precautions and abstain from the use of cotton swabs
-
Otomycosis of the ear canal is also treated with topical antifungal preparations as well as acidification
-
Otitis media with tympanic membrane perforation should be treated with systemic antibiotics; precautions should be taken with topical antibiotics because many are known to be ototoxic (only ofloxacin is approved for usage in the middle ear)
-
Foreign bodies in the ear can be removed with alligator forceps under direct visualization, or the patient can be referred to an otolaryngologist emergently
-
Patients with cholesteatoma, mastoiditis, and cerebrospinal fluid leak should be emergently referred to an otolaryngologist
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Otorrhea (Ear Discharge):
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Suction and debride the external auditory canal
-
Maintain dry ear precautions
–No water at all allowed within ear canals
-
Ototopical antibiotics
–Unless TM is intact, use nonototoxic (e.g., fluoroquinolone) drops
–Antifungal solution for candidal infections
-
Steroid drops
–Often a combination product with antibiotic drops
–Essential if granulation tissue is present
-
Reacidification of canal
–Acetic acid drops
–Treats both fungal and bacterial infections
–Painful if TM is not intact
-
Oral antibiotic
–For refractory cases of middle ear etiology
-
Prolonged IV antibiotics for severe refractory cases
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Otitis media:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In acute suppurative otitis media, antibiotic therapy includes amoxicillin. In areas with a high incidence of beta-lactamaseproducing H. influenzae and in patients who aren’t responding to ampicillin or amoxicillin, amoxicillin/clavulanate potassium may be used. For those who are allergic to penicillin derivatives, therapy may include cefaclor or co-trimoxazole. Severe, painful bulging of the tympanic membrane usually necessitates myringotomy. Broad-spectrum antibiotics can help prevent acute suppurative otitis media in high-risk patients. A single dose of ceftriaxone 50 mg/kg is effective against major pathogens but is expensive and is reserved for very sick infants. In the patient with recurring otitis media, antibiotics must be used with discretion to prevent development of resistant strains of bacteria.
In acute secretory otitis media, inflation of the eustachian tube using Valsalva’s maneuver several times a day may be the only treatment required. Otherwise, nasopharyngeal decongestant therapy may be helpful. It should continue for at least 2 weeks and, sometimes, indefinitely, with periodic evaluation. If decongestant therapy fails, myringotomy and aspiration of middle ear fluid are necessary, followed by insertion of a polyethylene tube into the tympanic membrane, for immediate and prolonged equalization of pressure. The tube falls out spontaneously after 9 to 12 months. Concomitant treatment for the underlying cause (such as elimination of allergens, or adenoidectomy for hypertrophied adenoids) may also be helpful in correcting this disorder.
Treatment for chronic otitis media includes broad-spectrum antibiotics, such as amoxicillin/clavulanate potassium or cefuroxime, for exacerbations of acute otitis media; elimination of eustachian tube obstruction; treatment for otitis externa; myringoplasty and tympanoplasty to reconstruct middle ear structures when thickening and scarring are present and, possibly, mastoidectomy. Cholesteatoma requires excision.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Otorrhea:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Advise the patient with chronic ear problems to avoid forceful nose blowing when he has an upper respiratory infection so that infected secretions are not channeled into the middle ear. Instruct him to blow his nose with his mouth open. Also, remind him to cleanse his ears with a washcloth only, and not to stick anything in his ear (such as a hairpin or a cotton-tipped applicator) that might cause injury. If the patient is a swimmer, instruct him to wear earplugs and to wash and dry his ears thoroughly after swimming. Have him report recurring ear pain and drainage, especially in the absence of upper respiratory infection, as this may be a sign of cancer.
Tell the patient with a ruptured tympanic membrane that such a rupture usually heals spontaneously. However, warn him to avoid immersing his head in water while it heals; tell him to insert lubricated cotton balls into his ear canal before he showers or shampoos.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Otitis media:
Treatment
(Handbook of Diseases)
The type of otitis media dictates the treatment guidelines.
Suppurative otitis media
With acute suppurative otitis media, antibiotic therapy may be prescribed if the disease is bacterial in origin. Nasal spray, nose drops, oral decongestants, or antihistamines may be used to promote drainage of fluid through the eustachian tube. Eardrops may be prescribed to relieve pain, as may analgesics such as acetaminophen. Oral corticosteroids may be used to reduce inflammation.
Severe, painful bulging of the tympanic membrane usually necessitates myringotomy. Broad-spectrum antibiotics can help prevent acute suppurative otitis media in high-risk patients. In patients with recurring otitis, antibiotics must be used with discretion to prevent development of resistant strains of bacteria.
CLINICAL TIP: Most patients who are receiving antibiotic therapy for acute otitis media have significant improvement in 48 hours.
Secretory otitis media
For patients with acute secretory otitis media, inflation of the eustachian tube by performing Valsalva’s maneuver several times a day may be the only treatment required. Otherwise, nasopharyngeal decongestant therapy may be helpful. It should continue for at least 2 weeks and sometimes indefinitely, with periodic evaluation.
If decongestant therapy fails, myringotomy and aspiration of middle ear fluid are necessary, followed by insertion of a polyethylene tube into the tympanic membrane, for immediate and prolonged equalization of pressure. The tube falls out spontaneously after 9 to 12 months. Concomitant treatment of the underlying cause (such as elimination of allergens, or adenoidectomy for hypertrophied adenoids) may also be helpful in correcting this disorder.
Chronic otitis media
Treatment of chronic otitis media includes broad-spectrum antibiotics for exacerbations of acute otitis media, elimination of eustachian tube obstruction, treatment of otitis externa, myringoplasty and tympanoplasty to reconstruct middle ear structures when thickening and scarring are present, and mastoidectomy. Cholesteatoma requires excision.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Earache:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient or his parents how to instill eardrops if they’re prescribed for home use. Encourage the patient to complete the full course of antibiotics if prescribed. If the patient experiences vertigo, tell him to rise slowly from a sitting or lying position. Warn the patient not to insert anything into the ear to avoid trauma, infection, and ear pain.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Otorrhea:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Advise the patient with chronic ear problems to avoid forceful nose blowing when he has an upper respiratory infection so that infected secretions aren’t channeled into the middle ear. Instruct him to blow his nose with his mouth open. Also, remind him to clean his ears with a washcloth only, and not to stick anything in his ear that might cause injury (such as a hairpin or a cotton-tipped applicator). If the patient is a swimmer, instruct him to wear earplugs and to wash and dry his ears thoroughly after swimming. Have him report recurring ear pain and drainage, especially in the absence of upper respiratory infection, because this may be a sign of cancer.
Tell the patient with a ruptured tympanic membrane that such a rupture usually heals spontaneously. However, warn him to avoid immersing his head in water while it heals; tell him to insert lubricated cotton balls into his ear canal before he showers or shampoos.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Otorrhea:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply warm, moist compresses, heating pads, or hot water bottles to the patient's ears to relieve inflammation and pain.
▪ Use cotton wicks to gently clean the draining ear or to apply topical drugs.
▪ Keep eardrops at room temperature because instillation of cold eardrops may cause vertigo.
▪ If the patient has impaired hearing, ensure that he understands everything that's explained to him, using written messages if necessary.
Patient teaching
▪ Instruct the patient on safe ways to blow his nose and clean his ears.
▪ Stress the use of earplugs when swimming.
▪ Explain signs and symptoms that require medical attention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Earache [Otalgia]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Administer an analgesic.
▪ Apply heat to relieve discomfort.
▪ Instill eardrops if necessary.
Patient teaching
▪ Teach the patient or the parents how to instill drops if they're prescribed for home use.
▪ Explain the importance of taking prescribed antibiotics correctly.
▪ Explain ways to avoid vertigo.
▪ Instruct the patient and family about ways to avoid ear trauma.
▪ Explain the cause of the earache once a diagnosis has been established.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Otitis Media and Sinusitis:
Management
(Pediatric Infectious Disease)
General Difficulties in Management of Otitis Media
1. There are increasing numbers of oral antibiotics available for the treatment
of otitis media, all claiming to be the
“best.” It should be remembered that most clinical trials evaluating antibiotics for
acute otitis media are designed to show the
“equivalency” necessary for U.S. Food and Drug Administration (FDA) approval. Most clinical
trials do not demonstrate superiority, and because of the relatively small
sample size in most clinical studies, antibiotics with limited efficacy can
actually appear to be equal to superior drugs.
2. Unlike many infectious diseases, clinical specimens are not routinely
collected for culture and sensitivity. The clinician, therefore, needs to
examine the tympanic membrane and make a best guess as to the bacteria
responsible.
3. There is increasing resistance to Streptococcus pneumoniae, the most common pathogen of otitis media. Two mechanisms of resistance have
emerged. For
S. pneumoniae, the most common cause of otitis media, resistance is due to alterations in
penicillin-binding proteins. Resistance to
S. pneumoniae is defined by the minimal inhibitory concentration (MIC) to penicillin and to
third-generation cephalosporins. Penicillin nonsusceptibility in the
pneumococcus is defined when the MIC to penicillin is greater than 0.1
µg/mL. The overall rate of penicillin nonsusceptibility for pneumococcus is at
least 30%. Pneumococcus isolates considered resistant to penicillin usually
have MICs greater than or equal to 2.0
µg/mL; these resistant pneumococcal strains have a high likelihood of resistance
to many antibacterial agents. For nonmeningeal infections, pneumococcus
nonsusceptibility to third-generation cephalosporins is defined as an MIC
greater than 2.0
µg/mL.
4. The other two major pathogens of otitis media are Haemophilus influenzae and Moraxella catarrhalis. For these organisms, resistance is due to β-lactamase formation. Forty percent of Haemophilus strains and virtually all Moraxella strains produce β-lactamase, making them resistant to amoxicillin.
Antibiotic Therapy for Otitis Media
Although there are only three major pathogens and only two major mechanisms of
resistance, there are many oral antibiotics available for treatment of acute
otitis media (Table 6.1). Several generalizations can be made about the many
oral antibiotics available for the treatment of acute otitis media. It is
important to realize that many of the newer, more expensive second- and
third-generation cephalosporins actually have reduced activity against the
increasing numbers of penicillin-intermediate and penicillin-resistant
S. pneumoniae.
1. The first-generation cephalosporins (Cephalexin) have little gram-negative
coverage and are usually used to treat gram-positive organisms such as
Streptococcus pyogenes and Staphylococcus aureus. Generally, first-generation cephalosporins are not used in the treatment of
acute otitis media.
2. The second-generation cephalosporins have moderate activity against
gram-positive infections with increasing activity against gram-negative
bacteria such as
M. catarrhalis and nontypeable H. influenzae. Cefaclor is the least potent of these antibiotics and, because of its
association with serum sickness, is generally not used. Cefuroxime (Ceftin) is
the most potent of these second-generation cephalosporins against penicillin
nonsusceptible pneumococcus, although it has the disadvantage of being
difficult for children to accept because of poor taste. Cefprozil (Cefzil) is
intermediate in both taste and potency.
3. The third-generation cephalosporins have excellent gram-negative activity.
However, activity against gram-positive organisms is variable. Cefixime
(Suprax) and ceftibuten (Cedax) have reduced efficacy against penicillin
nonsusceptible
S. pneumoniae and are poor choices for the treatment of acute otitis media caused by this
organism. These agents have good activity against penicillin-sensitive
pneumococcus as well as
β-lactamase–producing H. influenzae and M. catarrhalis.
4. The macrolide antibiotics include erythromycin, clarithromycin, and
azithromycin. Although these were formerly front-line therapies for sinusitis
and acute otitis media, there has been increasing resistance of pneumococcus,
group A streptococci, and
H. influenzae to macrolide antibiotics. Currently, about 30% of all strains of S. pneumoniae demonstrate in vitro resistance to macrolides. Although the exact relationship of in vitro macrolide resistance to actual clinical outcome is not always clear, many
specialists believe that these drugs are poor agents for the treatment of upper
respiratory infections and should be reserved for use in the management of
lower respiratory infections in children who are likely to have atypical
pathogens, such as
Mycoplasma pneumoniae and Chlamydia pneumoniae.
5. Trimethoprim-sulfamethoxazole (Bactrim) was previously a mainstay of therapy
for the treatment of sinusitis and acute otitis media. There has been increased
resistance of
S. pneumoniae to trimethoprim-sulfamethoxazole (more than 30%), and it is no longer
recommended as front-line therapy.
Treatment Recommendations
In 1999, the Centers for Disease Control and Prevention convened a working group
that published recommendations regarding the treatment of acute otitis media.
Initial treatment was recommended with amoxicillin at a dose of 80 to 100 mg/kg
per day. Amoxicillin given at the previous standard doses of 40 to 45 mg/kg per
day was determined not to achieve middle ear fluid levels that would eradicate
the increasingly prevalent penicillin nonsusceptible pneumococcal strains. The
increase in dosing to 80 to 100 mg/kg per day was thought to achieve higher
antibiotic levels in the middle ear and be effective against these strains.
This regimen would also be efficacious against
M. catarrhalis and H. influenzae strains that did not produce β-lactamase.
Treatment failures, defined as lack of clinical improvement after 3 days of
therapy, would likely be secondary to resistant pneumococcus or
β-lactamase–producing H. influenzae or M. catarrhalis. The panel recommended the following treatment options:
• Cefuroxime axetil (Ceftin)
• Intramuscular ceftriaxone (Rocephin)
• Amoxicillin clavulanate (Augmentin)
• Clindamycin
There was excellent logic to these recommendations. However, it should be
remembered that these were guidelines developed at a certain time. The panel
did state that, at the time of publication, there was not enough evidence of
efficacy for certain drugs against the resistant pneumococcus that may be
responsible for most treatment failures. In the subsequent years, the rates of
resistance of
S. pneumoniae have only increased. Additional developments regarding treatment of
penicillin-nonsusceptible and penicillin-resistant
S. pneumoniae also include the following:
1. There remains limited clinical experience using clindamycin, and no consensus
exists on the actual number of injections of intramuscular ceftriaxone required
for treatment of acute otitis media. Some investigators have found that up to
three intramuscular injections are needed for resolution of acute otitis media.
2. New formulations of antibiotics have become available, including high-dose
amoxicillin combined with clavulanic acid (Augmentin ES, 600 mg per 5 mL).
3. Experience has increased in the treatment of resistant S. pneumoniae with several third-generation oral cephalosporins, such as cefdinir and
cefpodoxime.
Recommendations for treatment of otitis media have recently been revised.
Amoxicillin remains the initial choice for primary therapy. Children at low
risk for infection with penicillin-nonsusceptible
S. pneumoniae can be treated with 40 mg/kg per day in two divided doses. Even with the S. pneumoniae classified as resistant to penicillin, it is thought that high-dose amoxicillin
(80 to 90 mg/kg per day) achieves sufficiently high levels in the middle ear to
achieve cure. In children with increased risk for infection with
penicillin-resistant
S. pneumoniae, including those younger than 2 years of age, attending daycare, or having
received antibiotics within the preceding 30 days, therapy should be started
using the high dose of 80 to 90 mg/kg per day in two divided doses.
For children with clinically defined treatment failure at 48 to 72 hours,
several antibiotics have been recommended as second-line therapy. Treatment
options include the following:
• Amoxicillin clavulanate, using the high-dose formulation of 600 mg per 5 mL,
given as 90 mg/kg per day of the amoxicillin component in two divided doses
• Oral therapy with cefdinir, cefuroxime axetil, or cefpodoxime
• Intramuscular ceftriaxone, 50 mg/kg for one to three doses
As resistance patterns change, recommendations will need to be updated.
Treatment Delay
As antibiotic resistance becomes more prevalent, there is continued discussion
about treatment delay in otitis media. It has been determined that a
significant percentage of acute otitis media resolves in 2 to 7 days without
antibiotic therapy. An increasing strategy, particularly in foreign countries,
is to withhold treatment in a patient with early otitis media. Children are
then rechecked in 48 to 72 hours to determine whether infection has resolved.
Delaying treatment does not substantially increase the risk for complications,
including the rate of severe mastoiditis.
Surgical Management of Otitis Media
The role of surgical intervention in patients with otitis media, particularly
recurrent otitis media, is often debated. There is concern about the effect of
recurrent otitis media and persistent middle ear effusions in young children at
the age of language development. Various studies have addressed the issue of
developmental outcomes in children with persistent otitis media and effusions.
Although a variety of conclusions have been drawn, a recent study reported no
improvement in the developmental outcomes at 3 years in children who had prompt
insertion of tympanostomy tubes by 9 months of life. Tympanostomy tube
insertion in children is often still considered if there is chronic effusion
lasting 3 months or longer, documented hearing loss, or recurrent otitis media,
defined as three or more episodes during the previous 6 months or four or more
episodes during the past year.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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