Treatment for ear pain

The pronounced staging of the acute otitis media process as the main cause of ear pain requires an individual approach to treatment at each of these stages. Particular importance at all stages is given to the restoration of the function of the auditory tube, which includes the use of vasoconstrictor drops in the nose, topical glucocorticoids endonasally, blowing the auditory tube, catheterization.

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

For local treatment of otitis, ear drops containing anti-inflammatory agents and anesthetics are used. The most advantageous is considered to be a combination of these components in one drug. A combination drug for the treatment of acute otitis is otipax, which contains srenazone - a non-steroidal anti-inflammatory drug and lidocaine - a local anesthetic.

Local use of antibacterial drugs in the treatment of acute otitis is very limited. This is due to the fact that antibiotics included in ear drops practically do not penetrate through the imperforate eardrum.

In case of perforated otitis, it is permissible to use antibiotic solutions for transtympanic administration. However, the use of ear drops containing antibiotics in case of damage to the integrity of the eardrum should be treated with special caution. It is necessary to remember that neomycin, gentamicin, polymyxin B and some other antibiotics included in most ear drops have an ototoxic effect, and the risk of their use may be high.

Antibiotics used locally 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 if the patient has severe somatic pathology (diabetes mellitus, kidney and blood diseases), antibiotics are prescribed for systemic use. Three conditions for the effectiveness of antibiotics are known:

• sensitivity of the pathogen to the antibiotic;
• the concentration of antibiotic in middle ear fluids and blood serum is higher than the MIC of the pathogen;
• maintaining serum concentrations above the MIC for 40-50% of the time between doses of the drug.

Oral medications that provide these conditions and, therefore, the leading medications for empirical therapy of acute otitis media in outpatient practice should be considered amoxicillin, as it is the most active against penicillin-resistant pneumococci, as well as macrolide antibiotics. In case of resistance of pathogens to camoxicillin, in case of persistent (recurrent) otitis media - amoxicillin with clavulanic acid (amoxiclav), cephalosporins and the latest generation of fluoroquinolones are prescribed.

Fluoroquinolones should be used with caution in uncomplicated forms of acute otitis media. It should not be forgotten that they are still considered reserve drugs, therefore, their use is more appropriate in cases of high risk of developing or existing complications of otitis media, as well as in cases of ineffectiveness of antibacterial therapy with other drugs.

Dosage regimens of the main oral and parenteral antibiotics in the treatment of acute otitis media

Oral medications
Antibiotic	Dosage regimen for adults	Dosage regimen for children	Relationship with food intake
First choice drugs:
Amoxicillin	500 mg3 times daily	40 mg/kg/day in 3 doses	Regardless of food
Amoxicillin/clavulanate (amoxiclav)	625 mg 3 times a day or 875 mg 2 times a day	50 mg/kg/day in 3 doses	During meals
Spiramycin (Rovacid)	3 million ME 3 times/day	1.5 million IU/20kg/day in 3 divided doses	Before meals
Alternative drugs:
Azithromycin	500 mg once a day, 3 days	10 mg/kg/day in 1 dose, 3 days	1 hour before meals
Midecamycin	400 mg 3 times a day	30-50 mg/kg in 2 divided doses	Before eating
Cefuroxime	250 mg 2 times a day	30 mg/kg/day in 2 doses	During meals
Cefaclor	500 mg 3 times a day	40 mg/kg/day in 3 doses	Regardless of food