What antibiotics are recommended for bullous myringitis with bacterial bronchitis (Bronchitis due to Bacterial infection)?

From the Guidelines

For bullous myringitis with bacterial bronchitis, co-amoxiclav 625 mg tds PO is the recommended first-line antibiotic treatment, as it provides effective coverage against common respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as suggested by 1. This recommendation is based on the guidelines for managing lower respiratory tract infections complicating influenza, which emphasize the importance of choosing an antibiotic that covers the likely bacterial pathogens.

• The preferred choice includes co-amoxiclav or a tetracycline, such as doxycycline, as stated in 1.
• A macrolide, such as clarithromycin, or a fluoroquinolone with enhanced pneumococcal activity, such as levofloxacin, can be considered as alternative choices, especially in cases of intolerance or resistance, as mentioned in 1 and 1.
• It is essential to note that the choice of antibiotic should be guided by local microbiological surveillance and the patient's specific circumstances, such as the presence of comorbidities or previous antibiotic use, as highlighted in 1.
• Patients should complete the full course of antibiotics, even if symptoms improve quickly, and seek follow-up care if symptoms worsen or do not improve within 48-72 hours of starting treatment, as emphasized in general clinical practice.
• Additionally, pain management with acetaminophen or ibuprofen and adequate hydration and rest are crucial to support recovery from both conditions, as part of comprehensive patient care.

From the FDA Drug Label

1.5 Acute Bacterial Exacerbation of Chronic Bronchitis Levofloxacin tablets are indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis.

Bullous myringitis with bacterial bronchitis may be treated with levofloxacin if the causative pathogens are susceptible, as it is indicated for acute bacterial exacerbation of chronic bronchitis due to certain bacteria, including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 2.

• Clarithromycin is also an option for the treatment of acute bacterial exacerbation of chronic bronchitis caused by susceptible isolates of Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, or Streptococcus pneumoniae 3.
• The choice of antibiotic should be based on culture and susceptibility testing when possible, and local epidemiology and susceptibility patterns should be considered in the empiric selection of therapy.

From the Research

Antibiotics for Bullous Myringitis with Bacterial Bronchitis

• The use of antibiotics in treating bullous myringitis with bacterial bronchitis is supported by several studies 4, 5, 6, 7.
• Bullous myringitis is often caused by bacterial pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, which are similar to those found in acute otitis media (AOM) without bullous myringitis 4, 7.
• Antibiotic therapy, such as amoxicillin/clavulanate or azithromycin, can effectively eradicate or suppress these bacterial pathogens, reducing the severity of symptoms and the risk of complications 5, 6.
• However, the use of antibiotics can also alter the competitive balance between organisms, leading to an increase in nasopharyngeal colonization with nonpneumococcal alpha-hemolytic streptococci (NPAHS) and other bacteria 6.
• The choice of antibiotic therapy should be guided by the susceptibility of the causative pathogens and the potential risks and benefits of treatment 5, 6.

Specific Antibiotic Regimens

• Amoxicillin/clavulanate has been shown to be effective in eradicating Streptococcus pneumoniae and Haemophilus influenzae, including strains with intermediate resistance to penicillin 5, 6.
• Azithromycin has also been used to treat bullous myringitis, but its effectiveness may be limited by the presence of azithromycin-resistant strains of Streptococcus pneumoniae 5.
• The use of large dosages of amoxicillin/clavulanate or azithromycin may be necessary to ensure adequate coverage of potential pathogens and to reduce the risk of treatment failure 6.

Considerations for Treatment

• The decision to use antibiotics in treating bullous myringitis with bacterial bronchitis should be based on the severity of symptoms, the presence of underlying medical conditions, and the potential risks and benefits of treatment 4, 7.
• Children with bullous myringitis may require aggressive pain management and close monitoring for potential complications, such as hearing loss or persistent otitis media 4.