What is the treatment for otitis media (ear infection)?

From the Guidelines

The treatment for an ear infection typically involves antibiotics, pain management, and supportive care, with amoxicillin being the recommended first-line therapy at a dosage of 80 to 90 mg per kg per day, as supported by the American Academy of Pediatrics and the American Academy of Family Physicians 1. When it comes to treating ear infections, the primary goal is to alleviate symptoms, prevent complications, and promote recovery.

• For bacterial ear infections (otitis media), oral antibiotics such as amoxicillin are commonly prescribed as first-line treatment.
• The dosage of amoxicillin should be 80 to 90 mg per kg per day, as recommended by the American Academy of Pediatrics and the American Academy of Family Physicians 1.
• For pain relief, over-the-counter medications like acetaminophen or ibuprofen can be used, with dosages of 10-15 mg/kg every 4-6 hours for acetaminophen and 10 mg/kg every 6-8 hours for ibuprofen.
• In some cases, antibiotic ear drops like ciprofloxacin with dexamethasone may be prescribed, particularly for outer ear infections (otitis externa).
• Applying a warm compress to the affected ear can help alleviate pain.
• It's essential to complete the full course of antibiotics even if symptoms improve before finishing the medication.
• For recurrent ear infections, especially in children, a doctor might recommend preventive measures or possibly ear tubes, as highlighted in a review of otitis media treatment and complications 1.
• A study published in Nature Reviews Disease Primers also emphasizes the importance of accurate diagnosis and symptomatic management of ear pain in the treatment of otitis media 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Otitis Externa The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. Acute Otitis Media in pediatric patients with tympanostomy tubes The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (from 1 to 12 years old) with tympanostomy tubes is: Five drops (0.25 mL, 0. 75 mg ofloxacin) instilled into the affected ear twice daily for ten days. Chronic Suppurative Otitis Media with perforated tympanic membranes The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.

The treatment for ear infection with ofloxacin (OTIC) depends on the type of ear infection and the patient's age.

• For otitis externa:
  • Pediatric patients (6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) once daily for 7 days.
  • Patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) once daily for 7 days.
• For acute otitis media with tympanostomy tubes:
  • Pediatric patients (1 to 12 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) twice daily for 10 days.
• For chronic suppurative otitis media with perforated tympanic membranes:
  • Patients 12 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) twice daily for 14 days 2.

From the Research

Treatment for Ear Infection

The treatment for ear infection, also known as otitis media, typically involves a combination of pain management and antibiotic therapy.

• The management of acute otitis media should begin with adequate analgesia 3.
• Antibiotic therapy can be deferred in children two years or older with mild symptoms 3.
• 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 3, 4.
• Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate 3.
• For patients in whom amoxicillin is unsuccessful, second-line therapy should have demonstrated activity against penicillin-resistant S. pneumoniae as well as beta-lactamase-producing pathogens 4.
• Appropriate options for second-line therapy include high-dose amoxicillin/clavulanate (90 mg/kg/day based on the amoxicillin component) and ceftriaxone 4.

Antibiotic Resistance

There is a rising concern about antibiotic resistance in the treatment of ear infections.

• The incidence of drug-resistant S. pneumoniae and beta-lactamase-producing organisms presents a clinical challenge for practitioners in the selection of empiric antimicrobial therapy 4.
• Isolates displaying resistance to one or more antimicrobial agents increased significantly in number for P. aeruginosa and H. influenzae 5.
• There was increased resistance to amoxicillin for P. aeruginosa and to erythromycin for H. influenzae 5.

Diagnosis and Management

The diagnosis and management of otitis media and otitis externa in adults are crucial.

• Acute otitis media and otitis media with effusion occur primarily in children, whereas acute otitis externa occurs with similar frequency in children and adults 6.
• Systemic antibiotics were prescribed in 75%, 63%, and 21% of AOM, OME, and AOE visits, respectively 6.
• Complications for otitis visits were low irrespective of antibiotic treatment 6.