Ear pharm Flashcards
FDA approved OTC for cerumen impaction
Carbamide Peroxide Solution 6.5%; >12 years of age
Carbamide peroxide names
Debrox
Mack’s Wax away
Murine for ear wax
Carbamide peroxide MOA
Urea and Hydrogen peroxide release oxygen which results in softening and removal of cerumen; weak antibacterial effects
When should carbamide peroxide be avoided?
Ear drainage/discharge
Ear pain
Rash/irritation in the ear
Injury/Perforation of the eardrum
Recent ear surgery
Dizziness
Carbamide peroxide instructions
Lie on bed, impacted ear upward, 5-10 drops, allow to remain several minutes, gently wash ear with warm water in syringe
*may need to repeat twice daily up to 4 days if needed
What should be avoided vs what can be used if ruptured TM
Avoid OTC otic preps
Avoid antibiotic drops except Fluoroquinolones +/- corticosteroids
First step to treat otitis externa
- Clean ear canal
- if intact TM: 3% hydrogen peroxide solution with water at room temp.
- if ruptured TM or unable to visualize: refer to otolaryngologist
Treat mild otitis externa
Topical acetic acid/hydrocortisone combination
Treat moderate otitis externa
First-line: Ciprofloxacin/hydrocortisone (Cipro HC) and Neomycin-polymyxin B-hydrocortisone (cortisporin)
Treatment of severe otitis externa
Topical antibiotic + antiseptic + glucocorticoid (same as moderate) and wick placement
If deep tissue infection - oral antibiotics + topical antibiotics
Oral agents - Ciprofloxacin 500mg BID or 10mg/kg/day, 2 doses, max 500mg for children
Treatment of otitis externa if patient is immunocompromised
Oral Ab + Topical Ab + Wick placement
Otitis externa patient education for drops
Tilt head toward opposite shoulder, pull auricle upward, fill ear canal with drops, lie on side 3-5 minutes or place cotton swab 20 minutes, typically 3-4 times per day for 7-14 days
What is the preferred topical agent for otitis externa
Topical fluoroquinolone
- better antimicrobial spectrum
- anti-inflammatory
- no ototoxicity
- Downside: cost, local irritation
Use of topical corticosteroids in otitis externa
Decrease inflammation/pain/pruritus
- hydrocortisone
- dexamethasone
- prednisolone
Use with antibiotic drops
Antiseptic and acidifying solutions for otitis externa
Bacteriostatic
Alcohol and acetic acid often used
Disadvantages: local irritation/burning/stinging
*DO NOT use with tympanic membrane perforation
What should be done if there is no response to treatment for otitis externa
Obtain culture
Consider referral to otolaryngologist
Consider CA-MRSA
Question Compliance/Water exposure
Relationship between otic drops and eye drops
Sometimes eye drops can be used in ear, Ear drops should NOT be used in the eye
What is the most common etiology of AOM
Strep pneumoniae
H. influenzae
M. cat
When does antibiotic treatment need to be used for AOM
<6 months of age
<24 months and bilateral AOM
>6 months if certain diagnosis AND moderate to severe otalgia
When should AOM be observed and not treated with antibiotics
- 6 months - 2 years if uncertain diagnosis and non-severe signs and symptoms
- > 2 years old without severe signs and symptoms
Antimicrobial treatment for AOM - children
Amoxicillin 80-90mg/kg/day
Augmentin 90mg/kg/day, 6.4mg/kg/day
If S. pneumoniae: Clindamycin alone
If S. pneumoniae + H. influenzae: add cephalosporin
When should tympanostomy tubes be considered - children
3 episodes in 6 months or 4 episodes in one year
What is the pathogenesis of AOM in adults
- Eustachian tube dysfunction
- Seasonal allergic rhinitis
- URI
What is often mistaken for AOM
Otitis media with effusion
What should be used to manage otitis media with effusion
Antihistamines, oral decongestants, nasal corticosteroids
First line treatment for AOM in adults
Amoxicillin/clavulanate 875/125mg BID
*higher doses if high risk for sever infection or resistant pathogens
Mild penicillin allergy - cephalosporin
Severe penicillin allergy - Doxycycline
When to refer AOM in adults
Recurrent AOM - >2 in 6 months
Persistent hearing loss following AOM
Chronic TM perforation following AOM >12 weeks
What 3 drug classes can cause ototoxicity
- Aminoglycosides - high frequency loss + dizziness
- Platinum compounds - high frequency loss + tinnitus
- Loop diuretics - sudden progressive SN loss, transient or permanent, dizziness
