From the Guidelines
Otic infections are typically treated with antibiotics such as amoxicillin or amoxicillin-clavulanic acid.
First-line and Second-line Treatments
- First-line treatment: Amoxicillin is the recommended first-choice antibiotic for treating acute otitis media, as suggested by the Expert Committee 1.
- Second-line treatment: Amoxicillin-clavulanic acid is recommended as a second-choice antibiotic for treating acute otitis media, especially in cases where the first-line treatment is not effective 1.
Other Treatment Options
- Ceftriaxone and cefuroxime are not recommended as first-line treatments due to concerns about penicillin-resistant Streptococcus pneumoniae and the preference for oral over intravenous or intramuscular treatments 1.
- For children with severe, persistent, or recurrent infections, antibiotics such as cefixime, cefpodoxime-proxetil, or cefuroxime-axetil may be prescribed 1.
- In cases of otitis associated with purulent conjunctivitis, antibiotics such as cefixime, cefpodoxime-proxetil, amoxicillin-clavulanate, or cefuroxime-axetil may be indicated 1.
Treatment Duration
- The treatment duration for acute otitis media is typically 8-10 days for children under 2 years of age and 5 days for older children 1.
Ventilation Tube-Associated Ear Discharge
- Ototopical antibiotic drops, such as those containing a combination of antibiotics and a corticosteroid, are recommended as first-line treatment for uncomplicated, acute ear discharge in children with ventilation tubes 1.
From the Research
Medications for Otic Infections
The following medications are used to treat otic infections:
- Neomycin and polymyxin combination, which offers a broad therapeutic spectrum against common pathogens 2
- Chloramphenicol (otic), an alternative for infections caused by bacteroides, but not by P aeruginosa 2
- Ofloxacin otic solution 0.3%, effective in treating otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes 3
- Acetic acid, aminoglycosides, polymyxin B, and quinolones, which are used as topical antimicrobials or antibiotics in uncomplicated cases of acute otitis externa 4
- Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate, for the treatment of otomycosis 5
- Nonciprofloxacin drops, which have a 70% cure rate in treating ciprofloxacin-resistant infections 6
Considerations for Treatment
When choosing a treatment, consider the following factors:
- Tympanic membrane status 2, 4
- Adverse effect profiles 3, 4
- Adherence issues 4
- Cost 4
- Presence of antibiotic resistance 6
Specific Infections and Treatments
- Otitis externa: treated with topical antimicrobials or antibiotics, such as neomycin/polymyxin B/hydrocortisone preparations 2, 4
- Otitis media: treated with ofloxacin otic solution 0.3% or oral amoxicillin/clavulanic acid 3
- Otomycosis: treated with topical antifungals, such as clotrimazole or miconazole 5
- Ciprofloxacin-resistant infections: treated with nonciprofloxacin drops or alternative therapy 6