Will Augmentin (amoxicillin-clavulanic acid) treat otitis externa?

Augmentin (Amoxicillin-Clavulanic Acid) for Otitis Externa

Augmentin (amoxicillin-clavulanic acid) is not recommended as first-line treatment for otitis externa, which should be treated with topical antibiotics rather than systemic antibiotics. 1

Appropriate Treatment for Otitis Externa

First-Line Treatment

• Topical therapy is superior to oral antibiotics for otitis externa
  • Non-ototoxic topical antibiotic preparations are recommended:
    • Fluoroquinolones (ofloxacin 0.3% or ciprofloxacin 0.2%) administered twice daily for 7-10 days 1
  • Aural toilet (cleaning) before medication administration is essential 1
  • Ear wick placement should be considered if the canal is severely edematous 1

Why Not Augmentin?

1. Pathogen coverage mismatch: Otitis externa is commonly caused by Pseudomonas aeruginosa 1, which is resistant to Augmentin 2
2. Evidence of superiority: Topical antibiotic therapy has shown superior outcomes compared to systemic antibiotics for ear infections with:
   • Higher clinical cure rates (77-96% with topical vs. 30-67% with systemic) 3
   • Better bacterial eradication 3
   • Higher patient satisfaction 3
3. Avoidance of adverse effects: Topical therapy avoids systemic antibiotic side effects including:
   • Dermatitis
   • Allergic reactions
   • Gastrointestinal upset
   • Oral thrush
   • Potential for increased antibiotic resistance 3

When Systemic Antibiotics May Be Indicated

Systemic antibiotics like Augmentin should be reserved for specific scenarios:

• Extension of infection outside the ear canal
• Presence of modifying factors such as:
  • Diabetes mellitus
  • Immunocompromised state
  • History of radiotherapy 1

Special Considerations

For Patients with Tympanostomy Tubes

• Avoid aminoglycoside-containing preparations due to potential ototoxicity
• Use only topical drops approved for use with tympanostomy tubes (e.g., quinolone drops) 3
• Limit topical therapy to a single course of no more than 10 days 3

For Fungal Otitis Externa

• Consider fungal etiology if not responding to antibacterial treatment within 48-72 hours
• Treat with azole antifungals such as clotrimazole or miconazole twice daily for 7-14 days 1

Prevention of Otitis Externa

• Keep ears dry
• Use ear protection when showering or washing hair
• Avoid ear canal cleaning with cotton-tip applicators 1

Follow-up Recommendations

• Reassess patients within 48-72 hours if no improvement
• Consider fungal otitis externa if not responding to antibacterial treatment
• Evaluate for other conditions if symptoms persist despite appropriate treatment 1

In summary, while Augmentin is effective for many respiratory and other infections, it is not the appropriate choice for treating otitis externa due to pathogen mismatch and the proven superiority of topical treatments.