From the Guidelines
For a 22-year-old male with chronic otitis media who last took Augmentin over six months ago, a fluoroquinolone such as ciprofloxacin is recommended, typically 500 mg orally twice daily for 7-10 days. This recommendation is based on the most recent and highest quality study available, which suggests that fluoroquinolones provide good coverage against Pseudomonas aeruginosa and other gram-negative bacteria commonly found in chronic ear infections 1.
Key Considerations
- The patient's previous treatment with Augmentin over six months ago suggests that there is a low risk of resistance to this antibiotic, but a fluoroquinolone is still preferred for chronic cases due to its broader coverage and penetration into the middle ear.
- Before starting antibiotics, ear cleaning by a healthcare provider is important to remove debris that might block antibiotic penetration.
- For topical treatment, ciprofloxacin/dexamethasone otic drops, 4 drops in the affected ear twice daily for 7 days, can be added if there is drainage.
- If symptoms don't improve within 48-72 hours, the patient should return for reassessment as culture-directed therapy might be necessary.
Alternative Options
- Alternatively, amoxicillin-clavulanate (Augmentin) could be used again at 875/125 mg twice daily for 7-10 days since sufficient time has passed since the previous course 1.
- However, the use of amoxicillin-clavulanate may not be as effective as a fluoroquinolone in chronic cases, and its use should be guided by the patient's specific clinical presentation and history of antibiotic use.
Monitoring and Follow-up
- The patient should be monitored closely for improvement in symptoms, and if there is no improvement within 48-72 hours, the patient should return for reassessment as culture-directed therapy might be necessary 1.
From the Research
Recommended Antibiotic for Chronic Otitis Media
The recommended antibiotic for a 22-year-old adult male with chronic otitis media, last treated with Augmentin (amoxicillin/clavulanate) over six months ago, can be determined based on the available evidence.
- The patient's previous treatment with Augmentin may not be effective due to potential resistance, as seen in some cases of chronic suppurative otitis media 2.
- Ciprofloxacin has been shown to be effective in treating chronic suppurative otitis media, with a bacteriologic eradication rate of 64.5% and a favorable clinical response in 67.1% of patients 3.
- However, resistance to ciprofloxacin has been reported in some cases, highlighting the need for susceptibility testing and alternative treatments 4.
- Other antibiotics, such as meropenem, imipenem, ceftazidime, amikacin, and piperacillin, may be effective against Pseudomonas aeruginosa, a common cause of chronic otitis media 5.
- Topical ciprofloxacin has been compared to intramuscular gentamicin and shown to be more effective in curing Pseudomonas-caused chronic otitis media in the acute stage 6.
Alternative Treatment Options
Alternative treatment options may include: