When to Use Oral Antibiotics
The AAO-HNSF clinical practice guideline on AOE unequivocally states that ototopical medications, and not systemic antibiotics, should be initial therapy for uncomplicated AOE. Two randomized controlled trials demonstrated no additional clinical benefit with the addition of an oral antibiotic to an ototopical therapeutic regimen for AOE.[21,22] Oral antibiotics have numerous well-documented adverse effects, ranging from rashes and allergic reactions to development of bacterial resistance. The AAO-HNSF guidelines on AOE also mention that the efficacy of numerous non-antibiotic ototopical medications was another argument against the use of oral antibiotics for routine, uncomplicated AOE. Of interest, in spite of the evidence against the use of oral antibiotics for uncomplicated AOE, the rate of oral antibiotic use in US ambulatory care centers actually increased from 21.7% to 30.5% after publication of the initial version of the AAO-HNSF guideline on AOE in 2006.
There are several specific situations in which systemic antibiotic therapy can serve as an effective adjunct to ototopical therapy for AOE.[3,4,24] If prescribed, systemic antibiotics should adequately cover such common AOE pathogens as P aeruginosa and Staphylococcus aureus. These specific situations include the following:
HIV infection, AIDS, or other conditions that can impair immune responses;
History of localized radiation therapy;
Infection extending outside the external auditory canal;
Active otologic complications such as osteitis, localized abscess, middle ear disease, or recurrent, persistent infections; and
Inability to effectively deliver topical antibiotics.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Managing Acute Otitis Externa: The Latest Guidelines - Medscape - Mar 02, 2016.