27. Ear infections

• 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.

• 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

• 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.

Amoxicillin or Amoxicillin/clavulanic acid

IF penicillin hypersensititvity: Azitrhomycin or clarithromycin