Middle ear infection (or otitis media) can occur at any age, but it is most common in infancy. A Boston City Hospital study estimated that 60 percent of infants (0-12 months) have had at least one episode of middle ear infection. The diagnosis of otitis media, or OM, is made when a physician sees fluid in the middle ear behind the eardrum, and when the patient experiences symptoms such as fever and ear pain. When the infection causes severe illness, treatment with antibiotics is recommended. This type of infection has several treatment options.
Amoxicillin
Amoxicillin is a drug that is related to penicillin. It is the first choice for treating OM in adults and children because it works well, it is fairly cheap and it is safe. Unlike some other antibiotics, it works against only a few types of bacteria, so it is less likely that resistant bacteria will develop from its use. According to the American Academy of Pediatrics and other medical groups, the recommended dosage of amoxicillin is 80 to 90 mg per kilogram of body weight per day. Side effects are rare and include dizziness, rash, diarrhea and nausea.
Cephalosporin Antibiotics
In people who are allergic to penicillin, but who do not have severe reactions to it (a severe reaction is one involving hives and difficulty breathing), a group of medications called the cephalosporins may work as an alternative to the first-choice penicillin. The cephalosporin medications include cefdinir and cefpodoxime. Cefdinir is usually 14 mg per kilogram of body weight per day, taken once daily, or divided into two doses; cefpodoxime is 10 mg per kilogram of body weight per day, taken once daily. A common side effect of cefdinir is diarrhea; less common effects include headache, rashes or nausea. The more common cefpoxidime side effects are specific to infants and toddlers and include diaper rash and diarrhea. Rare side effects include nausea, vomiting, abdominal pain and rashes. Ceftriaxone is another cephalosporin that is given as an injection into the muscle. One dose of this medication, at 50 mg per kilogram of body weight, is enough to yield high enough concentrations of the antibiotic for two days. For children whose penicillin allergy does not involve hives and breathing problems, this shot may be a good alternative therapy. Because ceftriaxone is injected, the most common side effects relate to the injection site, which may become red, warm or feel tight. Other side effects are similar to the other cephalosporins and may include rashes and diarrhea.
Macrolide Antibiotics
Another group of antibiotics is called the macrolide antibiotics, and some of the medications in this group have been approved by the Federal Drug Administration for the treatment of OM. These include azithromycin (taken once daily for five days) and clarithromycin (taken twice daily for 10 days). Erythromycin is another macrolide that may be given with the antibiotic sulfisoxazole; however, it must be taken three to four times daily, which may be difficult for patients to manage. Side effects within this class include a serious heart condition called QT prolongation; this is more commonly seen as a side effect of erythromycin. Other side effects of macrolide antibiotics include nausea, vomiting, diarrhea and liver damage.
Trimethoprim-sulfamethoxazole
Trimethoprim-sulfamethoxazole (TMP-SMX) is another option for treating OM in patients who are allergic to penicillin and are not able to take amoxicillin. Side effects include headache, rashes, nausea, vomiting and muscle pain. Pneumococcus, one of the most common bacteria that causes OM, may be resistant to this antibiotic so this medication should be used in those cases with caution.
References
- "UpToDate"; Denise S. Basow; 2010
- "Emergency Medicine: A Comprehensive Study Guide"; Judith Tintinalli et. al.; 2004
- "Pediatrics"; Diagnosis and Management of Acute Otitis Media"; American Academy of Pediatrics; May 2004
- "The Journal of Infectious Diseases"; Epidemiology of Otitis Media During the First Seven Years of Life in Children in Greater Boston: A Prospective, Cohort Study; D.W.Teele et. al.; July 1989
