otitis%20media%20-%20acute
OTITIS MEDIA - ACUTE
Otitis media is a general term used to describe inflammation of the middle ear which may be caused by an acute infection.
The symptoms are usually nonspecific and include otalgia (pulling of ear in an infant), irritability, otorrhea with or without fever.
Symptoms of upper respiratory tract infection may also be present.

Pharmacotherapy

Symptomatic Therapy

Analgesics

  • Eg Paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) [eg Ibuprofen]
    • Opioids may occasionally be indicated
  • Considered the mainstay of pain relief for acute otitis media (AOM)
  • Effective analgesia for mild-moderate pain

Antibiotic Therapy

  • There are no data regarding initially withholding antimicrobial therapy in adult patients w/ AOM
    • Treatment prevents development of complications

Amoxicillin/High-dose Amoxicillin

  • Amoxicillin at sufficient doses is still considered the 1st-line agent for AOM
  • It is effective against most of the bacteria which cause AOM including susceptible & intermediate-resistant pneumococci
  • In areas where Penicillin-resistant pneumococci are common, high-dose Amoxicillin should be given

Amoxicillin/clavulanic Acid (High dose)

  • High doses of Amoxicillin combined w/ clavulanic acid are recommended for patients who fail standard Amoxicillin therapy or in those who present w/ severe illness
  • This combination will provide coverage for beta-lactamase-producing organisms (eg H influenzae & M catarrhalis along w/ Penicillin-resistant S pneumoniae)

Cephalosporins (2nd & 3rd Generation)

  • Cefdinir, Cefpodoxime, Cefprozil & Cefuroxime are the preferred agents because of their effectiveness against drug-resistant S pneumoniae, H influenzae & M catarrhalis
    • These agents may be considered in patients w/ non-type 1 hypersensitivity reaction to Penicillin
  • Ceftriaxone [intravenous (IV)/intramuscular (IM)] may be considered in patients unable to take oral medications (eg vomiting)
    • Also recommended x 3 days in patients who fail Amoxicillin/clavulanate
    • Has superior efficacy to S pneumoniae compared w/ alternative oral antibiotics

Co-trimoxazole

  • Co-trimoxazole may be considered in patients w/ type 1 allergy to Penicillin
  • Use may be limited by local resistance patterns

Erythromycin/sulfafurazole

  • May be considered in patients w/ type 1 allergy to Penicillin
  • Depending on local resistance patterns, may be preferred over Co-trimoxazole

Advanced Macrolides

  • Eg Azithromycin or Clarithromycin
  • Active against the major pathogens that cause AOM
  • These agents have decreased activity against drug-resistant S pneumoniae

Clindamycin

  • May be considered in a patient who has persistent AOM after previous complete antibiotic therapy & in whom tympanocentesis is not possible for Gram stain & culture
  • Clindamycin may be effective against Penicillin-resistant pneumococcal infection not responding to other treatment
  • Clindamycin is not active against H influenzae or M catarrhalis & should not be used if these are suspected

Duration of Antibiotic Therapy

  • Optimal duration of antimicrobial therapy in AOM patients is uncertain
    • May continue antibiotics x 5-7 days in mild-moderate illness & up to 10 days if severe
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