Otic Drugs

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Author:
sdelap
ID:
117731
Filename:
Otic Drugs
Updated:
2011-11-18 15:59:06
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Otic drugs
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Otic drugs
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  1. Otitis Anti-Infectives
    • If not allergic to PCN:
    • Amoxicillin - drug of choice
    • Augmenten (amoxicillin + Clavulanate) for more severe cases

    • If allergic (mild Rxn) to PCN:
    • Broad spectrum PCNs (Acillins)
    • cefdinir (Omnicef)
    • ceftriaxone (Rocephin)

    • If allergic (severe Rxn) to PCN:
    • Macrolides (broad-spectrum) (mycins):
    • azithromycin (Zithromax)
    • clarithromycin (Biaxin)
    • erythromycin
    • clindamycin
  2. SE of Augmentin (amoxicillin + clavulanate)
    • Diahrrea
    • $$$$$
  3. Treatment plan for otitis media
    • < 6 months - antibiotics immediately
    • > 6 months - wait 48 hours to see if self-resolving
    • > Risk pts - treat immediately
    • Try not to use antibiotics
  4. AOM diagnosis
    Certain - Requires ALL of the following
    Uncertain - May not have ALL of the symptoms
    • Rapid onset of signs/symptoms
    • Middle ear effusion w/pain, bulging
    • Middle ear inflammation
  5. Severe vs. nonsevere otitis media
    • Severe:
    • Moderate to severe ear pain or fever > 39deg C

    • Nonsevere:
    • Mild ear pain or fever 30deg C
  6. Otitis Media S/S
    • Ear pain/fullness, hrg impairment
    • Child irritable, tugging ear, dist. sleep/eat patterns
    • Fever UNCOMMON
    • Purulent drainage, red, bulging tympanic membr
  7. Choices for resistant Otitis Media
    • Augmentin
    • Omniceph
    • Rocephen

    If not improved in 48 - 72 hours.
  8. Prevention of Otitis Media
    • Risk factors: daycare, pacifier, <2yo, recent abx in 3 months
    • Immunizations: influenza vacc = 30% reduction
    • Pneumonia vaccine = 6% reduction
  9. Otitis Externa Risk Factors
    • Excessive cleaning - Q tips
    • Scratching
    • Swimming
    • Hearing aids, headphones, ear plugs
  10. S/S Otitis Externa
    • Acute pain
    • Itching
    • Inflammation
    • Watery discharge
    • Hearing loss
  11. Tx Otitis Externa
    • Clean the ear canal (water/saline - not Q tips)
    • Acetic Acid - prevents growth of psuedomonas and staph
    • Hydrocortisone (inflammation/pain)
    • Topical antibiotics
  12. Otitis Externa Topical Antibiotics
    • Aminoglycosides: Gentamicin, Tobramycin, Polymixin B + Neomycin
    • Fluoroquinolones: Ciprofloxacin, Ofloxacin
  13. Tx Otitis Externa
    • Systemic abx (aminoglycs, fluoroquins)
    • Acetic acid 2%
    • Clotrimazole 1%
  14. Etiology of Cerumin Impaction
    • Narrow/misshaped ear canal
    • Excessive hair growth
    • Hearing aids/ Ear plugs
    • Elderly
    • Overactive ceruminous glands
  15. Tx Cerumin Impaction
    • Carbamide peroxide 6.5%: FDA approved softening agent for >12yo
    • Mechanism: release of O2 from peroxide + urea, tissue debridement, cerumin breakdown
    • Dosing: BID 4days

    Lubricants/emolients: docusate Na, glycerine, olive oil, 1 - 1 H2O + peroxide
  16. Prevention of Cerumin Impaction
    • Use warm washcloth, not Qtip
    • Only clean whats visible
  17. Treatment of Water-clogged Ears
    • Non-pharm:
    • Tilting ear down, pulling ear down
    • Blow dryer

    • Pharm drying agents:
    • Isopropyl alcohol: may be mixed w/ glycerin (emolient) or boric acid (incr acidity + weak germacide)
    • Acetic acid: bacteriacidal/antifungal, <pH
    • Boric acid: <pH, weak germicide

    • NO ear drying agents with:
    • Ruptured eardrum
    • Ear tubes
  18. Do NOT self treat ears if:
    • S/s infection
    • Ear discharge w/pain
    • Bleeding or s/s trauma
    • Ruptured tympanic membrane
    • Ear surgery <6 wks
    • Tubes
    • <12yo
  19. Ear Drops
    • Body temp
    • Adult ear: pull back and up
    • Child ear: pull back and down
    • May need to hold position after drops administered
  20. Drug of choice Otitis Media
    Amoxicillin
  21. Drug of choice Otitis Externa
    Topical acidifying / antimicrobial agents
  22. (Acetic acid + mycin or floaxin)

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