What is the approach for otitis externa?
Initiate supportive therapy as needed, e.g., analgesia, ear wick, aural toilet.
Evaluate for indications for systemic antibiotic therapy in AOE and start if present.
For uncomplicated AOE, initiate topical therapy for OE. [3]
Antibiotic (ofloxacin, ciprofloxacin, or gentamicin) or antiseptic ear drops
Preparations may be combined with glucocorticoids.
What are indications and coice of agent for systemic ABs in OE?
Indications
Topical antimicrobial administration is not possible.
Disease extension outside the ear canal, e.g.:
Cellulitis of the neck or face
Suspected MOE
Concomitant AOM
Uncontrolled diabetes
Immunosuppression
Previous local radiotherapy
Choice of agent: should cover P. aeruginosa and S. aureus, e.g., ciprofloxacin
What are adverse effects of gentamycin/neomycin/streptomycin etx (aminoglycosides)?
Nephrotoxicity
Ototoxicity and vestibulotoxicity (risk of ototoxicity is higher when used concurrently with loop diuretics) resulting in:
Tinnitus
Ataxia
Vertigo
Not if tympanic membrane ruptured
Neuromuscular blockade
Teratogenicity
Use quinolones in patients with nonintact (perforated or tympanostomy tube) TM or if the TM cannot be visualized; use of other topical agents risks iatrogenic hearing loss.
What is the first line treatment for otitis media as empiric AB if no Ab use in previous 30 days?
Amoxicillin or Amoxicillin/clavulanic acid
IF penicillin hypersensititvity: Azitrhomycin or clarithromycin
Last changed2 years ago