What oral antibiotic is recommended for an inner ear infection with dizziness?

Oral Antibiotics for Inner Ear Infection with Dizziness

For inner ear infections with dizziness, amoxicillin-clavulanate is the recommended first-line oral antibiotic due to its effectiveness against the most common pathogens and its ability to overcome beta-lactamase resistance. 1

First-Line Treatment Options

• Amoxicillin-clavulanate is the preferred oral antibiotic for inner ear infections with dizziness as it provides coverage against both Streptococcus pneumoniae and beta-lactamase producing organisms like Haemophilus influenzae and Moraxella catarrhalis 1
• Alternative beta-lactamase-stable agents include cefuroxime-axetil and cefpodoxime-proxetil, which also provide good coverage against the common pathogens in ear infections 1
• Standard dosing for adults should be sufficient, but higher doses may be necessary in cases of suspected resistant organisms 2

Treatment Algorithm Based on Clinical Presentation

• If dizziness is accompanied by purulent drainage from the ear:

  • Topical antibiotic drops (ofloxacin or ciprofloxacin-dexamethasone) should be the primary treatment 1
  • Oral antibiotics should be added only if the patient is very ill or if the infection doesn't respond to topical therapy 1

• If dizziness is present without drainage:

  • Amoxicillin-clavulanate is the first-line oral antibiotic 1
  • Treatment duration should be 5-10 days depending on severity and response 1

Alternative Options for Penicillin-Allergic Patients

• For patients with true penicillin allergy:
  • Trimethoprim-sulfamethoxazole or erythromycin-sulfisoxazole can be used 1, 3
  • Azithromycin should only be considered in patients who cannot tolerate other alternatives, due to increasing resistance patterns 4

Important Clinical Considerations

• Bacterial pathogens to target include S. pneumoniae, H. influenzae, and M. catarrhalis 1
• Be aware that 20-30% of H. influenzae and 50-70% of M. catarrhalis strains produce beta-lactamase, making amoxicillin alone potentially ineffective 1
• Clinical improvement should be expected within 48-72 hours of starting appropriate antibiotic therapy 1
• If symptoms worsen or fail to improve after 48-72 hours, reassessment is necessary 1

What to Avoid

• Antivirals should not be routinely prescribed for inner ear infections with dizziness, as there is no evidence of efficacy and they may cause side effects including nausea, vomiting, photosensitivity, and rarely neurological reactions 1
• Vasodilators and vasoactive substances should not be routinely used as they lack proven efficacy and may cause adverse effects including allergic reactions, bleeding, hypotension, arrhythmias, and seizures 1
• Ciprofloxacin should not be used if there is known ciprofloxacin resistance, as topical ciprofloxacin monotherapy has been shown to be successful in only 2.7% of ciprofloxacin-resistant infections 5

Follow-up Recommendations

• If symptoms persist despite appropriate antibiotic therapy, consider referral to an otolaryngologist for further evaluation 1
• Persistent dizziness may require additional vestibular assessment and management beyond antibiotic therapy 6
• For recurrent infections, antibiotic prophylaxis may be considered 1