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Suggest Treatment For Persistent Ear Infection Despite Taking Amoxicillin

Posted on Thu, 23 Mar 2017

Question: Hello, Dr. Zografakis. My wife visited her primary physician who discovered an ear infection despite the 10 days of amoxicillin. She said it was too early to prescribe another antibiotic, so instead gave her ofloxacin 0.3% solution for at least one week (eye drops used for ears too because very high cost of ear drops is not covered by insurance). How is it possible that although the Augmentin (50mg x 3 times a day) was for sinuses/chest (which helped), shouldn't it have taken care of the developing bacterial infection in the ears as well especially after 10 days (which she finished a couple of days ago)?! It seems very strange. Will she likely have to take a different type of antibiotic after 1 week, and if so which one might it be? Thank you.

Answered by Dr. Panagiotis Zografakis (1 hour later)

Brief Answer:
can't explain this strategy...

Detailed Answer:
I'm sorry but I can't explain why an antibiotic might be needed in a week but not now! If there are signs of acute otitis media then treatment should be initiated. The ofloxacin solution can be given for external otitis only... I don't understand... it's either an external otitis or a strange treatment strategy.

I thought she had amoxicillin only. Amoxicillin with clavulanate is a more potent antibiotic and should be effective for most cases of otitis. If it fails then levofloxacin tablets would be a good next choice (750mg per day, once daily for 5 days).

Kind regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (41 minutes later)

Thank you. Do you think the ten day prescription at 50mg 3X day was sufficient? Is it useless for her to use the drops if she blows or holds her nose and feels the discomfort or pain ? She explained her symptoms to her primary doctor, and she got the drops. It's difficult to get an early appointment to an ENT doctor now.

Answered by Dr. Panagiotis Zografakis (1 hour later)

Brief Answer:
500mg tid is not enough...

Detailed Answer:
You're welcome!

For acute otitis media 500mg of amoxicillin alone three times per day (I suppose you meant 500 instead of 50) is not enough. External otitis can be diagnosed based on symptoms or otoscopic findings. Pain when moving the pinna or exerting pressure on the tragus. Otoscopic findings include swelling, redness and exudate inside the ear canal.

Pain when blowing the nose is expected in acute otitis media.

Ear drops do not help in acute otitis media... They may only help in external otitis.

I can't diagnose anything from afar but there are some questions to be answered in this case...

Kind Regards!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar