Inflammatory diseases of the middle ear are an important clinical and social problem. This is due to their prevalence among all age categories, untimely access to an ENT doctor and frequent attempts at self-treatment, significantly increasing the risk of intracranial complications and irreversible hearing loss of varying severity.
Properly selected antibiotics for otitis media, procedures that improve the drainage function of the auditory tube, the elimination of foci of primary and chronic infection, which provoked inflammation, and qualified surgical assistance (if necessary) can minimize the number of life-threatening and health consequences.
Causes of inflammation
The frequency of this pathology, the severity of the course and the variety of developmental mechanisms are due to anatomical and physiological features.
In adults, the auditory tube has a relatively larger lumen than in children, and is located above the nose at an angle of 45 degrees to the ear. It opens in the nasopharynx at the level of the inferior nasal concha. With a wide opening of the mouth, swallowing and yawning, the mouth of the tube opens, which is a predisposing factor to the spread of infection from the nasal cavity or throat. Hypertrophy of the tube and pharyngeal tonsils also impedes the normal ventilation of the tympanic cavity and can cause a serious inflammatory process.
For otitis, the risk factor also serves: general body sensitization, chronic tonsillitis, antritis and rhinitis, in children – adenoid vegetation.
The inflammatory process is usually associated with bacterial flora, less often the cause is fungi or viruses.
Therefore, antibiotics for otitis in adults and children form the basis of treatment. The initial course is conducted empirically, with broad-spectrum antimicrobial agents covering the entire range of suspected pathogens (pneumo, strepto-and staphylococcus, hemophilus bacillus).
Further adjustment, if necessary, prolongation of therapy is based on the results of flora sowing on sensitivity. The duration of treatment depends on the severity of the inflammatory process, the state of the immune system, the presence of complications and comorbidities.
- For the duration of the flow:
- acute otitis media – up to three weeks;
- subacute – from three weeks to three months;
- chronic – over three months.
- According to the type of inflammatory process:
- By localization of inflammation:
- external otitis;
- otitis media
Can also join:
- myringitis (affected eardrum);
- mastoiditis (inflammation of the mastoid process);
- labyrinthitis (joins the inner ear).
- intraperitoneal (rupture of the eardrum, neurosensory hearing loss – according to the type of damage to the sound-conducting apparatus, tympanosclerosis, paralysis of the facial nerve);
- intracranial (meningitis, epidural abscess, subdural empyema, otogenic encephalitis, brain abscess, lateral sinus thrombosis, otogenic cerebral dystrophy).
As a rule, the inflammatory process involves the tympanic cavity, the auditory tube and the mastoid process. The defeat of the structures can be combined, therefore, when making a diagnosis, the preferential localization of the pathology in a particular department is taken into account.
Consider the treatment of the disease, depending on its established form.
Antibacterial therapy of otitis media exudative form
The disease is manifested persistent serous inflammatory process that affects the mucous membrane of the auditory tube and eardrum.
Antibiotics for ear pain in an adult, prescribed in the early stages of inflammation (before perforation appears), help prevent further progression of the pathological process and avoid irreversible hearing impairment.
Four stages of the disease
- Catarrhal stage (Eustachitis). Clinically manifested by mild tinnitus and unexpressed hearing loss.
- In the secretory phase, mucus accumulates in the tympanic cavity. Patients complain about the feeling of pressure and pressure in the ear, the feeling of iridescent fluid in the ears when bending and turning the head.
- In the mucosal stage, the secret becomes viscous and thick. Signs of hearing loss are pronounced. When perforating the membrane, sticky, sticky contents are pulled out from the ear, trailing behind a cotton swab.
- In the fibrous stage, a pronounced irreversible decrease in hearing is observed, adhesive otitis media is formed.
Treatment of otitis media with antibiotics in adults, accompanied by exudative inflammation
Therapy begins with the restoration of patency and normal functioning of the pipe. Use the method of blowing the ears by Politzer or using a catheter. Massage the tympanic membrane according to Sigl.
Purging of the auditory canal according to the method of Politzer
During the procedure, hormone preparations (hydrocortisone ®), antibiotics, enzymatic agents (trypsin ®, chymotrypsin ®) are injected through the catheter. Effective appointment of electrophoresis with leadazu ® or proteolytic enzymes.
Mandatory component of treatment are general antihistamine therapy and the use of vasoconstrictor drops in the nasal passages.
Fortifying actions are shown: vitamin therapy, use of immunocorrectors (polyoxidonium ®).
Antibiotics for ear pain in an adult are used systemically and locally.
- Penicillins with spread spectrum of action (Ampicillin ® and Amoxicillin ®) and inhibitor protected (Amoxicillin / clavulanate ®, Ampicillin / sulbactam ®) are considered the drugs of choice for systemic use.
- Ampicillin ® for oral use is prescribed 500 mg four times a day. When administered intravenously – up to 6 g, for four injections.
Amoxicillin ® for otitis in adults
Amoxicillin ® take 500 mg every 8 hours. When the severity of the inflammatory process 1 g three times a day.
Treatment of pregnant women is carried out strictly under medical supervision.
Amoxiclav ® is used in dosage from 375 to 625 mg every eight hours, or 1 g twice a day (preferably consumed during meals).
For severe forms of the disease, amoxiclav ® in otitis in adults is used by parenteral administration.
Antibiotics for external otitis
This term implies an inflammatory lesion of the outer part of the ear canal. The disease is usually preceded by injury or water entering the ear.
The main symptoms are: sharp ear and headache, itching and burning of the skin, unpleasant purulent odor, the presence of abnormal discharge.
With the progression of the infectious process, it is possible to completely block the ear canal with the further spread of inflammation inside.
Diagnostics is based on clinical examination data, complaints and test results.
The blood is characterized by signs of bacterial inflammation (most often): accelerated erythrocyte sedimentation rate, leukocytosis, neutrophilia with a shift to the left. In the presence of an allergic component, eosinophilia is diagnosed (more often in the chronic form).
Basic principles of therapy
Treatment includes hygienic care of the ear canal. The introduction of antibiotics in the ear with otitis combined with steroid drops. In severe pathological process, with a tendency to deepen inflammation and the involvement of adjacent anatomical structures, systemic antibacterial therapy has been shown.
- Amoxiclav ® in otitis is prescribed in standard dosages.
- With beta-lactam-resistant flora or the presence of Pseudomonas aeruginosa, fluoroquinolones (Ciprofloxacin ®, Norfloxacin ®) are prescribed.
- Amoxicillin ® with external otitis media is prescribed 1000 mg every eight hours.
Antibiotics for acute purulent otitis media
Inflammatory-infectious process covers the mucous membrane of the tympanic cavity and affects the anatomical structures of the middle ear. Antibiotics for the ears should be prescribed from the first hours of acute inflammation.
Consider the 3 stages of the disease.
Accompanied by severe pain, general intoxication, cognitive hearing loss. Pain in the ear sharp, intense, radiating to the temporal region, steadily progressive. This is due to the accumulation in the tympanic cavity of the pathological exudate and stimulation of the receptors of the glossopharyngeal and trigeminal nerve. The general condition of the patient is violated, the temperature can rise to 38-39 degrees.
- antimicrobial therapy (penicillins, second generation cephalosporins, macrolides);
- antihistamines (Loratadin ®, Erius ®, Diazolin ®);
- decongestants (oxymetazoline and xylometazoline derivatives are used);
- local anti-inflammatory therapy in the nose (bioparox ® – withdrawn from sale, IRS – 19 ®) and ear (Otinum ®, Otipaks ®, boric, furatsillinovogo alcohol).
Azithromycin ® for otitis in the non-perforated stage
Macrolide. Recommended his appointment in case of allergy to beta-lactam drugs or the presence of contraindications to their use. Used for mild diseases.
It is applied in a daily dose of 500 mg for three to five days. Recommended use for an hour before meals.
Paracentesis of the eardrum is indicated according to indications:
- the disease lasts more than three days;
- severe intoxication is expressed (meningism, convulsive syndrome, high fever, severe pain syndrome);
- bulging of the eardrum, the smoothness of the identification points during otoscopy.
Paracentesis is called a puncture of the eardrum, followed by suction of the pathological fluid through a needle from the cavity of the middle ear.
Myringotomy is performed, as a rule, after paracentesis. The procedure involves the dissection of the membrane, with the removal from the cavity of the products of pathological secretion. The cavity is washed with antibiotics.
The rupture of the eardrum is accompanied by otorrhea, a decrease, even disappearance, of the pain syndrome, an improvement in the state of health, and a persistent hearing loss. Suppuration may persist for up to five days.
Antimicrobial therapy is prescribed as indicated.
Drops for otitis in adults with antibiotic effective in the perforating stage
Antibacterial water-based drops are buried in the ears after a dry toilet of the external auditory canal:
- Anauran ®.
- Otofa ®.
- Polydex ®.
- Effective antibiotics for purulent otitis media for adults when sowing Pseudomonas aeruginosa (Normaks ®, Cipromed ®).
Combined aerosol preparations of oxytetracycline and hormonal substances:
- Oxycyclozol ®.
- Levovinisol ®.
- Vinisol ®.
Local anti-inflammatory drugs in the nasal passages:
- Nazivin ®.
- Nazol ®.
- Renorus ®.
- Otrivin ®.
- Tizin ®.
It is characterized by scarring of the damaged part of the eardrum and the complete disappearance of otorrhea and pain. The health of the patient is normalized, the hearing gradually returns.
To accelerate the recovery, blowing and catheterization of the auditory tubes, pneumomassage of the eardrum are used. Effectively prescribing physiotherapy UHF, electrophoresis with lidzoy – endauralno.
Basic antibiotics for otitis
Often, antibiotics for otitis media in adults and children are taken without taking into account antibiogram data, in an insufficient one-time and daily dose, in a too short course, which leads to the transition of the process to the chronic stage, recurrence or the development of severe complications.
The answer to the question: what antibiotics should be used for ear otitis in adults? – based on the principles of rationality and validity of antimicrobial therapy. Preparations for starting empirical treatment are chosen taking into account the main pathogens. Preference is given to semisynthetic broad-spectrum penicillins. Amoxiclav ® in otitis, is the drug of choice.
Ototoxic antibiotics for otitis are completely excluded.
In the presence of allergic reactions to beta-lactam agents, some macrolides are prescribed (Sumamed ®, Roxithromycin ®).
The course of treatment is 10-14 days, one drug is recommended to use 7-10 days. If necessary, extend therapy, the drug is a mandatory change.
Ciprofloxacin is used only for external otitis, as well as in cases where inflammation is caused by pyocyanic sticks.
Additional otitis therapy
Comprehensive treatment includes the appointment of gammaglobulin, ribonuclease, leukocyte interferon (intranasal).
Effective drug nasal electrophoresis with drugs.
Anti-inflammatory therapy, sanitation of the upper respiratory tract, desensitizing and general strengthening therapy are carried out.
Antrodrainage and antrotomy, with the introduction of drugs into the ear cavity, are carried out in the absence of positive dynamics from the applied therapy.
Check out our article about antibiotics for ENT diseases.