Ear infections (topicals) Archives - MPR

Acute Otitis Media Treatments

Haymarket Media — Tue, 21 Oct 2014 15:00:00 +0000

ACUTE OTITIS MEDIA TREATMENTS
Generic	Brand	Strength	Form	Dose	Duration²
FIRST LINE ANTIBIOTIC THERAPY¹
amoxicillin³	—	125mg/5mL, 200mg/5mL, 250mg/5mL, 400mg/5mL	susp	80−90mg/kg/day³ in 2 divided doses every 12hrs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin ES⁵	600mg/42.9mg per 5mL	susp	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): 90mg/kg/day in 2 divided doses every 12hrs; ≥40kg: not established; use tabs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin	875mg/125mg	tabs	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): use Augmentin ES susp; (≥40kg): 875mg every 12hrs
ALTERNATIVE ANTIBIOTIC THERAPY⁶
cefdinir	—	125mg/5mL, 250mg/5mL	susp	<6mos: Not recommended. 6mos−12yrs: 7mg/kg every 12hrs or 14mg/kg every 24hrs; max 600mg/day	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
cefuroxime	—	250mg, 500mg	tabs	<13yrs (able to swallow tab): 250mg twice daily	Mild to moderate: <2yrs: 10 days,2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
cefpodoxime	—	50mg/5mL, 100mg/5mL	susp	<2mos: Not recommended. 2mos−12yrs: 5mg/kg (max 200mg) every 12hrs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
ceftriaxone	—	500mg, 1g	IM inj	50mg/kg (max 1g) IM once	1 day⁷
ANTIBIOTIC FAILURE⁹
amoxicillin/ clavulanate⁴	Augmentin ES⁵	600mg/42.9mg per 5mL	susp	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): 90mg/kg/day in 2 divided doses every 12hrs. ≥40kg: not established; use tabs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin	875mg/125mg	tabs	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): use Augmentin ES susp; (≥40kg): 875mg every 12hrs
ceftriaxone	—	500mg, 1g	IM inj	50mg/kg (max 1g) IM daily	3 days
clindamycin⁶	Cleocin	75mg/5mL	oral soln	30−40mg/kg/day in 3 divided doses with or without 3rd generation cephalosporin¹⁰	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
PAIN MANAGEMENT¹¹
acetaminophen	Children’s Tylenol	160mg/5mL	susp	Give every 4hrs as needed. 6–11lbs: 40mg. 12–17lbs: 80mg. 18–23lbs: 120mg. 24–35lbs: 160mg. 36–47lbs: 240mg. 48–59lbs: 320mg. 60–71lbs: 400mg. 72–95lbs: 480mg. ≥96lbs: 640mg. Max 5 doses/day	As long as needed
ibuprofen	Children’s Motrin	100mg/5mL	susp	<6mos: Not recommended. Give every 6–8hrs as needed. ≥6mos: 12–17lbs: 50mg. 18–23lbs: 75mg. 24–35lbs: 100mg. 36–47lbs: 150mg. 48–59lbs: 200mg. 60–71lbs: 250mg. 72–95lbs: 300mg	As long as needed
NOTES
¹ The American Academy of Pediatrics (AAP) recommends antibiotic therapy for children aged ≥6mos with severe signs and symptoms (eg, moderate to severe otalgia or pain lasting for ≥48hrs, or temp ≥102.2°) and bilateral acute otitis media (AOM) in children aged <24mos without severe symptoms. For unilateral AOM in children aged 6−23mos and bilateral/unilateral AOM in children aged ≥24mos without severe disease, antibiotic therapy or observation with close follow-up based on shared decision-making with the caregiver is recommended (initiate antibiotic therapy if no clinical improvement within 48−72hrs of symptom onset). ² AAP recommends variable duration of therapy depending on age and severity of symptoms. ³ The AOM guideline recommends high dose amoxicillin (off-label) as the first line therapy for children with no penicillin allergy who haven’t received amoxicillin in the past 30 days or absence of concurrent purulent conjunctivitis. ⁴ Consider if previously received amoxicillin in the past 30 days, concurrent purulent conjunctivitis syndrome is present, or history of recurrent AOM unresponsive to amoxicillin. ⁵ Not interchangeable with other formulations of amoxicillin/clavulanate suspension due to the clavulanate component (6.4mg/kg/day; 14:1 ratio). ⁶ Alternative for patients with penicillin allergy. ⁷ The guideline suggests that 3 days of ceftriaxone therapy may be required to prevent recurrence of infection within 5−7 days after the initial dose. ⁸ For intratympanic administration only, in patients with bilateral otitis media with effusion undergoing tympanostomy tube placement. ⁹ Antibiotic therapies after 48−72hrs of failure of initial antibiotic treatment. ¹⁰ Alternative therapy for patients with failure to second antibiotic is clindamycin plus 3rd generation cephalosporin. ¹¹ As per the AOM guideline, analgesics should be given for the management of otalgia, especially for the first 24hrs of presentation, regardless of antibiotic use and should be continued as long as necessary. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.
REFERENCES
Liberthal AS, Carroll AE, Chonmaitree T, et al. Clinical Practice Guideline: the Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131:e964-e999. (Rev. 2/2024)

CIPRO HC OTIC

Haymarket Media — Thu, 22 Jul 2021 10:27:46 +0000

Ciprofloxacin (as HCl) 0.2%, hydrocortisone 1%; otic susp.

CIPRODEX OTIC

Haymarket Media — Thu, 22 Jul 2021 10:27:47 +0000

Ciprofloxacin (as HCl) 0.3%, dexamethasone 0.1%; otic susp.

COLY-MYCIN S OTIC

Haymarket Media — Thu, 22 Jul 2021 10:27:52 +0000

Colistin (as sulfate) 3mg, neomycin (as sulfate) 3.3mg, hydrocortisone acetate 10mg, thonzonium bromide 0.5mg; per mL; otic susp; contains thimerosal.

CORTISPORIN-TC OTIC

Haymarket Media — Mon, 30 Jan 2023 21:39:24 +0000

Colistin (as sulfate) 3mg, neomycin (as sulfate) 3.3mg, hydrocortisone acetate 10mg, thonzonium bromide 0.5mg; per mL; otic susp; contains thimerosal.

Ofloxacin Otic Solution

Haymarket Media — Thu, 22 Jul 2021 10:29:15 +0000

Ofloxacin 0.3%.

Otic Preparations

Haymarket Media — Tue, 20 Nov 2012 02:00:00 +0000

Otic Preparations

OTIC PREPARATIONS
Generic	Brand		Form
ANTIBIOTICS
ofloxacin 0.3%	—	Rx	soln
ANTIBIOTICS + CORTICOSTEROIDS
ciprofloxacin 0.3% + dexamethasone 0.1%	Ciprodex	Rx	susp
ciprofloxacin 0.3% + fluocinolone acetonide 0.025%	Otovel	Rx	soln
ciprofloxacin 0.2% + hydrocortisone 1%	Cipro HC Otic	Rx	susp
colistin sulfate 3mg/mL + neomycin sulfate 3.3mg/mL + hydrocortisone acetate 10mg/mL + thonzonium bromide 0.5mg/mL	Coly-Mycin S Otic¹	Rx	susp
	Cortisporin‑TC Otic¹	Rx	susp
polymyxin B sulfate 10000 U/mL + neomycin sulfate 3.5mg/mL + hydrocortisone 10mg/mL	—	Rx	susp
	—	Rx	soln²
CERUMINOLYTICS
carbamide peroxide 6.5%	—	OTC	soln
	Debrox	OTC	soln
	Murine Ear	OTC	soln
DRYING AGENTS
isopropyl alcohol 95% + anhydrous glycerin 5%	Auro-Dri	OTC	soln
isopropyl alcohol 95% + anhydrous glycerin 5%	Swim Ear	OTC	soln
STEROIDS
fluocinolone acetonide 0.01%	Dermotic Oil³	Rx	drops
Warming an otic product by holding the bottle in hand for 1−2 min may minimize dizziness and pain on application; do not heat above body temperature.
Classes & Pharmacology
Antibiotics: Neomycin is active against S. aureus, E. coli, H. influenzae, K. pneumoniae, Enterobacter, Neisseriae, P. aeruginosa. Neomycin can cause hearing loss and should usually not be used for more than 10 days; it can also cause sensitization. Ofloxacin is a fluoroquinolone antibiotic active against S. aureus, P. aeruginosa, P. mirabilis, S. pneumoniae, H. influenzae, M. catarrhalis. Ciprofloxacin is a fluoroquinolone antibiotic active against S. aureus, P. mirabilis, P. aeruginosa. Colistin is active against most strains of gram negative bacteria including P. aeruginosa, E. coli, K. pneumoniae, Aerobacter. Corticosteroids: Hydrocortisone controls inflammation, edema, pruritus. It should not be used in the presence of local viral infections and it can impede wound healing. Ceruminolytics: Carbamide peroxide mechanically softens and loosens excessive ear wax. Triethanolamine polypeptide oleate is a surfactant that breaks up cerumen. Drying Agents: Isopropyl alcohol and anhydrous glycerin have surface-tension releasing properties which dislodge trapped water from the sides of the ear canal, allowing it to run out or evaporate. Preservatives: Thimerosal (a mercury derivative), parabens, sulfites, oxyquinoline sulfate, or benzalkonium chloride may cause sensitization. Benzalkonium chloride also reduces surface tension. Excipients and Vehicle: Propylene glycol, polysorbate 80 aid in product formulation. Products that contain hydrochloric acid should be used only in the presence of an intact eardrum. Surfactants: Thonzonium bromide is a surface-active agent that promotes tissue contact by dispersion and penetration of the cellular debris and exudate.
NOTES
¹Contains thimerosal ²Contains sulfites ³Contains peanut oil Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 2/2024)

OTOVEL

Haymarket Media — Thu, 22 Jul 2021 11:41:54 +0000

Ciprofloxacin 0.3%, fluocinolone acetonide 0.025%; otic soln; preservative-free.

Polymyxin B/Neomycin/Hydrocortisone Otic Soln

Haymarket Media — Mon, 30 Jan 2023 21:40:02 +0000

Polymyxin B sulfate 10000Units, neomycin sulfate 3.5mg, hydrocortisone 10mg; per mL; contains sulfites.

Polymyxin B/Neomycin/Hydrocortisone Otic Susp

Haymarket Media — Mon, 30 Jan 2023 21:40:29 +0000

Polymyxin B sulfate 10000Units, neomycin sulfate 3.5mg, hydrocortisone 10mg; per mL.