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Acute Otitis Media & Externa - #MEDSHED

Updated: Nov 14, 2023

Welcome to the #MEDSHED! Needing a brief, concise review of clinical pharmacotherapy and disease management? Direct links of reference to content discussed? Look no further than the #MEDSHED series based on infographics and carousel presentations!



📢 #MEDSHED - Acute Otitis Media & Acute Otitis Externa


Mastoiditis can lead to abscess formation, clot development, and bacterial meningitis. This is progression of acute otitis media (AOM) affecting the mastoid air cells, which release push and cause these complications. Think otitis media, middle ear, closer to respiratory orgnaisms. The common bugs are S. pneumoniae, H. influenzae, and M. catarallis. First line therapy is oral Augmentin (amox-clav). Alternatives include 2nd/3rd gen cephalosporins, azithromycin, doxycycline, and levofloxacin. I’d select the best antibiotic according to your local antibiogram; ask your pharmacist if you don’t know what that is. Topical ear drops have limited efficacy for AOM, even in the setting of a ruptured tympanic membrane. Don’t let a simple infection turn into a life-threatening complication.


Hearing loss is the last of your worries if you don’t address that ear infection. Don’t get acute otitis media twisted up with otitis externa. With acute otitis externa, think outter ear, swimmers ear. We know that pseudomonas loves aquatic environments. Additionally, we’ll cover for staphylcoccus sp. Note these organisms are different than the respiratory bugs associated with AOM. Topical ear drops that cover PsA are first line therapy for acute otitis externa. Most of these ear drops are expensive, neomycin-polymixinb-hydrocortisone and ofloxacin are likely the cheapest while being effective for your patient. Check for a ruptured tympanic membrane or if you don’t have a clear visual, avoid ear drops that contain acids, alcohols, or aminoglycosides. The ear drops of choice for these cases are fluoroquinolones, such as ofloxacin and ciprofloxacin.

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