Uso de antibioticoterapia sistemica na otite externa

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Uso de antibioticoterapia sistemica na otite externa

Mensagem  Tulio Henrique Versiani em Sex Maio 22, 2015 12:36 am

Systemic antibiotics:

-Do not use systemic antimicrobial therapy as initial therapy for diffuse uncomplicated acute otitis externa unless there is extension outside ear canal or presence of specific host factors that would indicate need for systemic therapy (AAO-HNSF Strong Recommendation, Grade B)
-Systemic antibiotics indicated for patients with conditions associated with increased morbidity and/or immunocompromise (including diabetes)
       extracanal manifestations including:
           pinna
           skin of neck or face
           deeper tissues
           auricular cellulitis
           cervical adenopathy
           parotitis
       moderate acute otitis externa in older patients
       coexisting otitis media
       malignant otitis externa
       circumstances preventing effective delivery of topical agents
   
-Ceftriaxone and amoxicillin-clavulanate associated with similar response rates in randomized trial of 100 patients with phlegmonous or abscess-forming ear, nose, and throat infections
-Oral trimethoprim-sulfamethoxazole appears ineffective for otitis externa based on randomized placebo-controlled trial in 105 patients taking triamcinolone acetonide/neomycin/nystatin/gramicidin ointment for acute diffuse otitis externa.
       
-Treatment of Pseudomonas aeruginosa infections:

   therapeutic bacteriophage preparation targeting antibiotic-resistant P. aeruginosa (Biophage-PA) may reduce symptoms and signs of chronic otitis externa due to antibiotic-resistant P. aeruginosa. Based on pilot randomized trial in 24 such patients
     
   treatment of auricular chondritis (infected upper ear cartilage piercing) should cover P. aeruginosa 25 suspected infections reported in 118 persons having 186 commercial ear piercings, all 7 with confirmed P. aeruginosa infections had ear cartilage piercings

    Case series of auricular chondritis from ear cartilage piercing show culture of P. aeruginosa and successful treatment with ciprofloxacin or IV antibiotics

No significant differences in outcomes comparing different antibiotic preparations (level 2 [mid-level] evidence)

-Based on systematic review of trials with varied methodologic quality systematic review of 20 randomized trials evaluating antibiotics in 3,289 patients with otitis externa trials were of varied methodologic quality and 50% were not double-blind (may be due to obvious differences in drug appearance or dosing schedule) comparisons included:
antimicrobial (antibiotic or antiseptic) vs. placebo in 2 trials
antiseptic vs. antimicrobial in 8 trials
quinolone antibiotic vs. nonquinolone antibiotic in 7 trials
steroid-antimicrobial vs. antimicrobial alone in 3 trials
antimicrobial-steroid vs. steroid alone in 2 trials
Clinical cure rates of 65%-90% within 7-10 days of therapy regardless of topical agent used

Reference - Otolaryngol Head Neck Surg 2006 Apr;134(4 Suppl):S24

Referencias - Med J Aust 1993 May 17;158(10):697 ; JAMA 2004 Feb 25;291(Cool:981; ORL J Otorhinolaryngol Relat Spec 1992;54(2):95 ; Clin Otolaryngol 2009 Aug;34

Tulio Henrique Versiani

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Data de inscrição : 27/03/2015

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