Show What are ototopical antibiotics?Ototopical antibiotics are applied as the first-line offense against middle ear infection. Ototopical antibiotics are medications administered topically in the ear for treating middle ear infections. Ototopical antibiotics are usually the first-line treatment for recurrent bacterial ear infections, in the absence of systemic infection. Ear infections are more common in children, and often clear up on their own. Most ear infections can be managed with warm compresses and pain management. Antibiotics are usually administered only for severe and persistent ear infections. What are the advantages of ototopical antibiotics?Administration of antibiotics directly in the ear has several advantages over systemic delivery including the following: Antibiotic concentration
Absence of systemic effects
Alteration of microenvironment
Treatment cost
What are the disadvantages of ototopical antibiotics?Ototopical antibiotics have a few disadvantages as well, which include the following: Difficult to administerDirect delivery at the infection site may be difficult or impossible sometimes. The medication may fail to reach the infected area in the middle ear if the ear canal is blocked due to:
Steps must be first taken to clear the blocks before antibiotic administration. Irrigating the ear canal can easily clear a block caused by earwax and other secretions, but an ear tube block and granulation each may require some procedure and other medications. Inflammation and complicationsOtotoxicity is toxicity to the ear from local administration. Ototoxicity can irritate and inflame the mucus membranes of the middle ear. If the antibiotic enters the inner ear, it may lead to:
Ototopical antibiotics can cause allergic reactions. Low-grade sensitivity reactions may cause persistent drainage that may be impossible to distinguish from drainage due to infection, making treatment difficult. Some people may also develop cross-sensitivity to related antibiotics. Absence of systemic effect
Alteration of microenvironment
What are the types of ototopical antibiotics?Ototopical antibiotics are available in three forms: PowdersPowders are not approved by FDA, but regionally compounded powders have been in use for years. Powders have the advantage of adhering to and remaining for a long time in moist surfaces. Powders are prepared with several components. Two preparations of powders used are: Creams and ointmentsCreams and antibiotics are applied only for bacterial and fungal infections in the external ear and auditory canal, usually with a single dose. Following are some of the antibiotic ointments and creams used for external ear infections: DropsDrops are the most commonly used form of ototopical antibiotics. Drops are available as:
In addition to antibiotics, medications added to ototopical combination products include the following: Steroids to reduce inflammation and improve recovery Antiseptics for use in external ear infections, because they have both antifungal and antibacterial properties. Some of the antiseptics used in ototopical preparations include:
Antifungal medications such as:
Some ototopical combination products do not have any antibiotics, instead relying on pH, viscosity and other chemical properties to kill the bacteria or control their growth by producing a hostile ear environment.
Which antibiotic is best for an ear infection?Two classes of antibiotics are commonly used to treat an ear infection. AminoglycosidesAminoglycosides have been the main treatment for bacterial ear infections for decades. Two aminoglycosides used in ototopical preparations are: Though both of the above are commonly used in the United States, only neomycin has FDA approval. Neomycin is effective for gram-positive bacteria but its effectiveness against gram-negative bacteria has declined over years, especially against Pseudomonas, the most common bacteria in ear infections. Tobramycin is effective for Pseudomonas and other gram-negative bacteria. QuinolonesQuinolones are the most recently introduced ototopical antibiotics. Most quinolone antibiotics in use are fluoroquinolones, which also contain an atom of fluorine. Fluoroquinolones are considered the best available treatment now for ear infections for two reasons:
Following are some of the FDA-approved fluoroquinolone solutions for external ear infection (acute otitis externa) from Staphylococcus aureus and Pseudomonas aeruginosa: Ciprofloxacin (Cetraxal)Side effects include:
Side effects include: Ofloxacin (Floxin Otic)Side effects include:
CortisporinContains hydrocortisone, neomycin and polymyxin B. Side effects include:
CiprodexContains ciprofloxacin and dexamethasone. Side effects include:
Contains acetic acid and hydrocortisone. Side effects include: Domeboro solutionContains aluminum acetate and acetic acid. Side effects include: See Answer Symptoms & Signs FAQs & Doctor's Views Medications FDA Drug Labels on RxList.com Health News Healthy Living By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Medically Reviewed on 7/21/2022 References Medscape Medical Reference |