From the Guidelines
Yes, it is possible to have both otitis externa and otitis media simultaneously, and treatment in a child typically involves antibiotic ear drops for the external infection and oral antibiotics for the middle ear infection, with pain management and ear care to prevent complications. When treating a child with both otitis externa and otitis media, it is essential to consider the most recent and highest quality evidence. According to the clinical practice guideline on acute otitis externa 1, topical antimicrobials are beneficial for treating the external infection, while oral antibiotics have limited utility. For the middle ear infection, the guideline on tympanostomy tubes in children 1 suggests that oral antibiotics are unnecessary unless the child is very ill or the infection does not respond to ear drops.
Key Considerations for Treatment
- Antibiotic ear drops containing ciprofloxacin or a combination of neomycin, polymyxin B, and hydrocortisone are typically prescribed for the external infection 1.
- Oral antibiotics such as amoxicillin (40-90 mg/kg/day divided twice daily for 10 days) may be prescribed for the middle ear infection, but only if necessary 1.
- Pain can be managed with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours).
- Keeping the ear dry during treatment is crucial, and this can be achieved by avoiding swimming and using a cotton ball coated with petroleum jelly during bathing 1.
- Warm compresses can help relieve pain and discomfort.
Importance of Medical Attention
It is crucial to seek medical attention for a child with both otitis externa and otitis media, as untreated infections can lead to complications, including hearing loss 1. The combination of these infections occurs because bacteria can spread between the ear compartments, with the external infection often involving the ear canal skin and the middle ear infection occurring behind the eardrum. By following the recommended treatment and taking steps to prevent complications, it is possible to effectively manage both otitis externa and otitis media in a child.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Otitis Externa:The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. Acute Otitis Media in pediatric patients with tympanostomy tubes:The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (from 1 to 12 years old) with tympanostomy tubes is: Five drops (0.25 mL, 0. 75 mg ofloxacin) instilled into the affected ear twice daily for ten days.
Yes, it is possible to have both otitis externa and media.
- For otitis externa in children (6 months to 13 years old), the treatment is 5 drops of ofloxacin otic solution (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for 7 days 2.
- For acute otitis media in children (1 to 12 years old) with tympanostomy tubes, the treatment is 5 drops of ofloxacin otic solution (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear twice daily for 10 days 2. Key considerations:
- The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness.
- The patient should lie with the affected ear upward, and then the drops should be instilled.
- For otitis media, the tragus should then be pumped 4 times by pushing inward to facilitate penetration of the drops into the middle ear.
From the Research
Can you have otitis externa and media
- Yes, it is possible to have both otitis externa and otitis media. Otitis externa is an infection of the outer ear canal, while otitis media is an infection of the middle ear [ 3, 4 ].
Treatment of otitis externa
- For otitis externa, treatment options include local ciprofloxacin or a combination of oxytetracycline, polymyxin B, and hydrocortisone [ 5 ].
- Oral ciprofloxacin has also been shown to be effective in the treatment of external bacterial otitis [ 6 ].
Treatment of otitis media in children
- For otitis media in children, the preferred treatment is amoxicillin or amoxicillin-clavulanate [ 3, 7 ].
- The dosage of amoxicillin is recommended to be 90 mg/kg/day, divided into three doses, for a duration of 5 days [ 7 ].