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Treatment of ear pain

 
, medical expert
Last reviewed: 20.11.2021
 
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The pronounced staginess of the process presupposes an individual approach to treatment in each of the stages of acute otitis media. Of particular importance at all stages is the restoration of the function of the auditory tube, which includes the use of vasoconstrictive drops in the nose, topical glucocorticoids endonasal, blasting of the auditory tube, catheterization.

It is also necessary to treat the diseases that led to tubal dysfunction, and consequently, to acute otitis media: acute and exacerbations of chronic nasopharyngitis, sinusitis, acute rhinitis. Of great importance in the treatment of these diseases is the normalization of the pathological viscous secretion of the nasal cavity, the paranasal sinuses and the auditory tube. Therefore, in the complex treatment of acute otitis it is advisable to include so-called secretolitic drugs, one of which is sinupret.

For topical treatment of otitis, ear drops are used, containing anti-inflammatory drugs and anesthetics. The most advantageous is the combination of these components in a single preparation. Combined drug for the treatment of acute otitis is otipax, containing senazone - a nonsteroidal anti-inflammatory drug and lidocaine - a local anesthetic.

The local use of antibacterial drugs in the treatment of acute otitis media is very limited. This is due to the fact that the antibiotics that make up the ear drops practically do not penetrate through the unperforated tympanic membrane.

With perforated otitis, antibiotic solutions for transtimpanal administration are allowed. However, the use of ear drops containing antibiotics, in violation of the integrity of the tympanic membrane should be treated with extreme caution. It must be remembered that neomycin, gentamicin, polymyxin B and some other antibiotics that are part of most ear drops have an ototoxic effect, and the risk of their use can be high.

Antibiotics applied topically do not replace systemic antibacterial therapy, since they do not affect the flora of the nasal cavity, paranasal sinuses and nasopharynx - the cause of otitis. In most cases, especially when the patient has severe somatic pathology (diabetes mellitus, kidney and blood diseases), antibiotics are prescribed for systemic use. There are three conditions for the effectiveness of antibiotics:

  • the sensitivity of the pathogen to the antibiotic;
  • the concentration of antibiotic in middle ear fluids and serum above the MPC of the pathogen;
  • the concentration in the blood serum above the MPC for 40-50% of the time between doses of the drug.

Oral preparations that provide these conditions, and therefore the leading drugs for empirical therapy of acute otitis media in outpatient practice, should be considered amoxicillin, since it is most active against penicillin-resistant pneumococci, as well as macrolide antibiotics. With the stability of kamoksitsillinu pathogens, with persistent (recurrent) average otitis - appointed amoxicillin with clavulanic acid (amoksiklav), cephalosporins and the last generation of fluoroquinolones.

The use of fluoroquinolones in uncomplicated forms of acute otitis media should be treated with caution. We must not forget that they are still considered as reserve drugs, therefore, their appointment is more appropriate if there is a high risk of development or a complication of otitis media, and in cases of ineffective antibacterial therapy with other drugs.

Modes of dosing of the main oral and parenteral antibiotics in the treatment of acute otitis media

Oral preparations

Antibiotic

Dosing regimen in adults

Dosage regimen in children

Relationship with food intake

Preparations of the first choice:

Amoxicillin

500 mg once per day

40 mg / kg / day in 3 divided doses

Regardless of food

Amoxicillin / clavulanate (amoksiklav)

625 mg once daily or 875 mg twice daily

50 mg / kg / day in 3 divided doses

While eating

Spiramycin (rovatsid)

3 million ME 3 times / day

1.5 million IU / 20 kg / day in 3 divided doses

Before meals

Alternative preparations:

Azithromycin

500 mg1 times a day, 3 days

10 mg / kg / day in 1 reception, 3 days

1 hour before meals

Midekamycin

400 mg 3 times a day

30-50 mg / kg in 2 divided doses

Before eating

Cefuroxime

250 mg twice daily

30 mg / kg / day in 2 divided doses

While eating

Cefaclor

500 mg 3 times a day

40 mg / kg / day in 3 divided doses

Regardless of food

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