From the Guidelines
Oral antibiotics are not the first-line treatment for otitis externa, but may be prescribed in severe cases or when the infection has spread beyond the ear canal, with fluoroquinolones like ciprofloxacin or levofloxacin being commonly used 1. When considering oral medication for otitis externa, it's essential to assess the severity of the infection and the patient's overall health status.
- The patient's medical history, including conditions like diabetes, HIV infection, or other immunocompromised states, should be taken into account, as these factors can increase the risk of complications and influence treatment decisions 1.
- Oral antibiotics may be necessary for patients with severe infections, such as necrotizing otitis externa, which can be life-threatening if left untreated 1.
- For patients with fungal infections, such as otomycosis, oral antifungals like fluconazole may be used, but topical antifungal therapy is often the primary treatment approach 1.
- It's crucial to note that oral antibiotics should complement, not replace, topical therapy, which remains the mainstay of treatment for otitis externa 1.
- Patients should be advised to keep the ear dry during treatment, avoid swimming, and use ear plugs when showering to prevent further irritation and promote healing.
- In cases where oral antibiotics are prescribed, the choice of antibiotic and duration of treatment should be guided by the severity of the infection and the patient's individual needs, with fluoroquinolones like ciprofloxacin (500mg twice daily for 7-10 days) or levofloxacin (750mg once daily for 7-10 days) being commonly used options 1.
From the Research
Oral Medication for Otitis Externa
- Otitis externa is a common ear infection that can be treated with oral medication in certain cases 2, 3.
- A study published in 2017 found that oral ciprofloxacin was effective in treating otitis externa, with complete resolution of the inflammatory process in 93% of patients with acute external bacterial otitis and 90% of patients with exacerbation of chronic otitis externa 2.
- The study also found that ciprofloxacin was well-tolerated, with no major side effects reported 2.
- Another study published in 1993 compared the effectiveness of local ciprofloxacin with a combination of oxytetracycline, polymyxin B, and hydrocortisone in treating otitis externa, and found that ciprofloxacin was more effective in eradicating bacterial pathogens 4.
- However, it's worth noting that oral antibiotics are typically only indicated if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immunosuppression 3.
Common Pathogens and Antimicrobial Sensitivities
- The most common pathogens responsible for otitis externa include Pseudomonas aeruginosa, Staphylococcus aureus, and Candida species 5.
- A study published in 2008 found that Pseudomonas aeruginosa was the most commonly identified pathogen in otitis externa, and that it was highly resistant to certain antibiotics, including neomycin, chloramphenicol, and amoxicillin 5.
- However, the study also found that Pseudomonas aeruginosa was highly sensitive to ciprofloxacin, polymyxin B, and gentamicin 5.
Treatment Guidelines
- The treatment of otitis externa typically involves analgesia, cleansing of the external auditory canal, and the application of antiseptic and antimicrobial agents 3.
- Topical antimicrobial treatments have been found to be effective in treating otitis externa, and corticosteroid preparations can help to reduce swelling, erythema, and secretions 3.
- Oral antibiotics may be indicated in certain cases, such as if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immunosuppression 3.