Swimmer’s ear - treat with topical antibiotic drops alone
Posted Jan 22 2010 12:00am
Published January 22nd, 2010
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CFAH.org - When treating the pain and inflammation of swimmer’s ear, antibiotic drops alone are the most effective — and safest – therapy, finds a new evidence-based Cochrane review of studies.
These findings might reduce the use of oral antibiotics, still prescribed in many cases of acute otitis externa — commonly known as swimmer’s ear — and so help prevent the development of dangerous antibiotic-resistant infections.
“Topical antibiotics are effective at treating simple acute otitis externa although in up to 40 percent of cases, oral antibiotics are also prescribed,” said lead author Vivek Kaushik, a consultant otolaryngologist at Stepping Hill Hospital in Stockport, England. “The findings from our review confirm that topical treatment alone is highly effective and that additional antibiotics are not required.”
The review compared the treatments used in 19 randomized controlled trials, conducted mostly in hospital settings. Treatments used on the 3,382 participants included topical antibiotics, oral antibiotics, combination treatments and over-the-counter acetic acid drops. While antibiotic drops have been the most common treatment for the past 50 years, it is desirable to reduce even the small percentage of cases where a clinician prescribes an additional oral antibiotic.
“Considering that acute otitis externa affects between one in 100 and one in 250 of the general population annually, even a 20 percent prevalence of oral antibiotic use in the U.S. would yield about 240,000 unnecessary annual antibiotic prescriptions at the low end,” said Richard Rosenfeld, M.D., chairman of otolaryngology at SUNY Downstate Medical Center. “Topical therapy is highly effective and can be done with either an antiseptic- or antibiotic-containing preparation, which may also contain a steroid.”
Avoiding the use or oral antibiotics can also reduce the risk of side effects such as rash or hypersensitivity. Antiseptic drops, also covered in the review, do not cause resistance and are effective against yeast and fungi as well, which cause a minority of ear infections.
“Some of the antiseptics included in our review were found to be as effective as antibiotic-containing drops,” Kaushik said. “Consequently, they should be considered an alternative when treating patients with this condition. It is, however, important to remember that your physician might prescribe additional oral antibiotics under certain circumstances, for example, if the infection has spread from the ear canal onto the ear or onto the face.”
The review recommends patients continue treatment for the full seven days and if symptoms persist, continue the treatment for a maximum of seven more days. Most patients improve within a week and a follow-up doctor’s visit is not required unless symptoms continue.
Affecting four of every thousand Americans each year, swimmer’s ear is seen in many age groups, but it is most common among children ages seven to 12 years and is five times more common in swimmers than non-swimmers.
“Swimming exposes the ear canal to water for long periods and results in maceration or breakdown of the ear canal skin,” Kaushik said. “It also washes away its protective waxy, acidic coating and allows bacteria in dirty or polluted water to enter the canal.”
People prone to repeated infections might want to take preventive measures such as using ear plugs or a bathing cap or blocking the ear canal with cotton balls smeared with petroleum jelly when swimming. The ear normally is self-cleaning, so otherwise leaving it alone is best.
“Avoid inserting anything into the ear canal, including cotton-tipped swabs,” Rosenfeld said. “If water in the ear is annoying after swimming or showering, the corner of a soft towel can be used to blot the water or a hair dryer on a low setting can dry out the canal.”
Anyone who suffers from repeated infections might want to use antiseptic drops after swimming or water exposure to reduce the chance of infection. A home-brew preparation made up of one-half white vinegar (acetic acid) and one-half rubbing alcohol can be as effective as commercial preparations, Rosenfeld said.
Reference: Kaushik, V et al. Interventions for acute otitis externa (Review). Cochrane Database of Systematic Reviews 2010, Issue 1.