What antibiotics cover Pseudomonas (Pseudomonas aeruginosa) otitis (infection of the ear)?

From the Guidelines

For pseudomonal otitis, the recommended antibiotic is ciprofloxacin otic drops (0.3%), administered as 3-4 drops in the affected ear twice daily for 7-10 days, as it has been shown to be effective in treating Pseudomonas aeruginosa infections, particularly in the context of tympanostomy tubes in children 1. The choice of ciprofloxacin is based on its efficacy against Pseudomonas aeruginosa, which is a common pathogen in otitis externa and tympanostomy tube-associated otorrhea, as highlighted in studies such as 1 and 1. Some key points to consider when treating pseudomonal otitis include:

• The importance of completing the full course of treatment, even if symptoms improve earlier, to ensure complete eradication of the infection.
• Keeping the ear dry during treatment to prevent further complications.
• The potential need for oral ciprofloxacin (500mg twice daily for 7-10 days) if the infection does not respond to topical therapy, especially in cases of external otitis that have spread beyond the ear canal.
• The use of combination therapy, such as ciprofloxacin with dexamethasone, to reduce inflammation in more severe infections.
• The consideration of alternative antibiotics, such as tobramycin or neomycin-containing preparations, in certain cases. It's also important to note that Pseudomonas aeruginosa is naturally resistant to many antibiotics due to its outer membrane permeability, efflux pumps, and ability to form biofilms, which is why specific antibiotics like ciprofloxacin are chosen for treatment, as discussed in 1 and 1. Overall, the treatment of pseudomonal otitis requires careful consideration of the underlying pathogen, the severity of the infection, and the potential need for combination therapy or alternative antibiotics.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of adults (≥ 18 years of age) with mild, moderate, and severe infections caused by susceptible isolates of the designated microorganisms in the conditions listed in this section

1. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa

Activity in vitro and in vivo Levofloxacin has in vitro activity against Gram-negative and Gram-positive bacteria fections as described in Indications and Usage (1):

Gram-Negative Bacteria

Pseudomonas aeruginosa

The antibiotic that covers Pseudomonas aeruginosa is levofloxacin. However, it is essential to note that the provided drug labels do not specifically mention Pseudomonas aeruginosa otitis. The information provided is about the general coverage of Pseudomonas aeruginosa by levofloxacin in various infections.

• Key points:
  • Levofloxacin has in vitro activity against Pseudomonas aeruginosa.
  • Levofloxacin is indicated for the treatment of complicated urinary tract infections due to Pseudomonas aeruginosa.
  • The provided drug labels do not specifically address Pseudomonas aeruginosa otitis. 2

From the Research

Antibiotics for Pseudomonas aeruginosa Otitis

• The following antibiotics have been studied for their effectiveness against Pseudomonas aeruginosa otitis:
  • Ciprofloxacin: shown to be effective against Pseudomonas aeruginosa in several studies 3, 4, 5
  • Levofloxacin: has been shown to have similar activity to ciprofloxacin against Pseudomonas aeruginosa 3
  • Imipenem: has been shown to be highly effective against Pseudomonas aeruginosa, with a susceptibility rate of 96.5% in one study 5
  • Piperacillin/tazobactam: has been shown to be effective against Pseudomonas aeruginosa, with a susceptibility rate of 37.5% in one study 5
  • Ceftazidime: has been shown to be effective against Pseudomonas aeruginosa, with a susceptibility rate of 31.8% in one study 5
  • Amikacin: has been shown to be effective against Pseudomonas aeruginosa, with a susceptibility rate of 55.6% in one study 5
  • Cefiderocol: a new cephalosporin that shows promising results against Pseudomonas aeruginosa 6

Resistance Patterns

• Resistance to antibiotics is a growing concern in the treatment of Pseudomonas aeruginosa otitis:
  • Ciprofloxacin-resistant Pseudomonas aeruginosa has been isolated in several studies 4, 5, 7
  • Multidrug-resistant Pseudomonas aeruginosa has been reported, with higher mortality rates among ICU patients 7
  • Continuous surveillance is necessary to monitor antimicrobial resistance and guide antibacterial therapy 5, 7