Acute Otitis Media:
The most common cause of fever is an acute ear infection or
acute otitis media.
This is an infection of the
middle ear
and
mastoid
cavity.
Mastoiditis
as used by the lay public actually refers to "Coalescent Mastoiditis" is
a severe infection where the infection in the mastoid cavity starts to
directly involve bone. Complications such as meningitis, brain
abscess or spread into the soft tissues of the skull may occur.
Acute otitis media
can be caused by a number of different bacteria. The most common
are: Streptococcus Pneumonia, Heamophilus Influenzae (this is not
the flu virus), Moraxella catarrhalis. Less commonly,
Mycoplasma Pneumoniae, Streptococcus Pyogenes, Staphylococcus Aureus
along with other bacteria and viruses. Antibiotic resistance is
not commonly seen in S. Pyrogenesis, S. Pneumonia and H. Influenza.
The resistance profile to S. Pneumonia can be extensive with few oral
antibiotics being effective. Because of bacterial resistance,
prophylactic antibiotics, are no longer used to prevent ear infections.
Although effective in preventing ear infections, these low dose
antibiotics promote and worsen bacterial resistance.
Acute
otitis media in a patient with a myringotomy is often caused by
Pseudomonas aeruginosa. Heslop et. al reported that topical
ciprofloxacin had a 23% failure rate which was lower than that found in
patients treated with oral amoxicillin or with saline rinses.
View Abstract
(The bacterial
resistance in S. Pneumonia is transmitted on a plasmid between the bacteria. A single
plasmid can carry the genes for resistance to both the penicillin and macrolide
antibiotics. This organism's resistance to penicillin is by
producing a penicillin binding protein and not by producing penicillinase (an
enzyme which breaks down penicillin. Thus, this organism will also be
resistant to Amoxcillin/Clavulanate and Amoxcillin/Sulbactam. The mechanism of penicillin resistance
in H. Influenzae is by the production of a B-lactamase which breaks down
penicillin. In this case, Amoxcillin/Clavulanate would be expected to be an
effective antibiotic since Clavulanate neutralized the B-lactamase
enzyme.)
Treatment is with oral antibiotics. In cases of bacterial
resistance, intravenous antibiotics may be necessary. Antibiotic
drops will not enter the
middle ear
and are not used in
acute otitis media
unless the eardrum has ruptured and pus is
draining out the ear canal.
Patient Suggestion For Adults with a Middle Ear Infection (Otitis
Media): Ask your doctor if a generic medication may be able to treat your
condition at a lower cost. For example:
A discount pharmacy was
consulted on Nov 20, 2007 (prices used in this example
may change and vary).
1) A 10 day supply of Augmentin XR taken two
tablets twice a day for 10 days cost $139.94.
A similar dosage can be obtained by taking generic
Augmentin 875 mg every twelve hours alternating
with Amoxicillin 1000 mg every twelve hours. These
dosages are alternated every size hours. Thus, a
total of four doses of antibiotics are taken each day.
Augmentin 875, Amoxicillin, Augmentin 875 and
Amoxicillin. The total cost of this medication
regiment is $66.98 a savings of $72.96.
Vaccines:H.Flue vaccine has dramatically reduced the incidence of infection to H.
Influenza Type B. A new vaccine Prevnar is a heptavalent
Pneumococcal Vaccine to Streptococcus Pneumonia. S. Pneumonia is a common cause of
otitis media. Unfortunately, many children who have recurrent otitis media
may have already been exposed to many of the various types of S. Pneumonia which
Prevnar vaccinates for. Often the main problem in children with chronic
otitis media, is not that they do not have antibodies to
the bacteria but that they have eustachian tube dysfunction. The
effectiveness of Prevnar in children who already have recurrent otitis media
needs more study.
Overall, in one study it was shown
that Prevnar reduced the rate of office
visits for otitis media by 7% and the placement of myringotomy tubes by 20%.
Left untreated 50% of all cases
of
acute otitis media
will clear without antibiotics, but 1 in 400 may progress to
acute
coalescent mastoiditis, a life threatening ear infection; and rarely
meningitis, a life threatening
brain infection, can occur. The infection can also spread from the
ear, usually behind the ear where cellulitis or abscess may develop.
Acute Otitis Externa:
This is an acute bacterial infection usually caused by Pseudomonas aeruginosa. The outer ear canal is swollen shut, and the
auricle
is very painful to touch. Treatment
is to open the ear canal, place a wick, and treat with ear drops.
The wick is made of cloth or foam rubber which will allow the ear drops
to penetrate the swollen canal. Unfortunately, most oral
antibiotics are ineffective. Oral fluoroquinolones can be
effective, but they are not approved in children.
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