Hello kangaa,
Before starting, I just want to say that although I have a BSc and PhD
in biomedicine, and so understand the concepts and language of
medicine, I am not a physician and what follows should be taken not as
full medical advice but as information to be used when discussing
further therapeutic options with your physician.
Normally, you should see improvement shortly after starting
antibiotics. The fact this is not so is due to the bacteria causing
the condition being resistant to the antibiotics tried so far. This
is an increasing problem, as more bacteria become resistant to more
antibiotics.
I have found a paper which deals with how to treat unresponsive or
recurring otitis media.
“Acute Otitis Media: Part II. Treatment in an Era of Increasing
Antibiotic Resistance”
by Michael E. Pichichero, M.D.of the University of Rochester Medical
Center, Rochester, New York, which appeared in American Family
Physician on April 15, 2000. You can read the whole paper on the web
site of the American Academy of Family Physicians at
http://www.aafp.org/afp/20000415/2410.html
I will summarise the main points here.
Basically, the strategy is to move to ever more powerful antibiotic
treatments, until one is found that solves the problem. The paper
lists a total of 15 antibiotics which can be used. With respect to
the organisms responsible for the problem, the author says:
“Currently, it appears that S. [Streptococcus] pneumoniae,
particularly penicillin-resistant strains, accounts for an increasing
number of pathogens in patients who fail to respond to antibiotic
therapy” and lists the following antibiotics as demonstrating “a
modest degree (60 to 80 percent) of clinical efficacy in the treatment
of acute otitis media caused by penicillin-resistant S. pneumoniae”:
high-dose amoxicillin (80 mg per kg per day), amoxicillin-clavulanate
(Augmentin), cefuroxime (Ceftin), cefprozil (Cefzil) and ceftriaxone
(Rocephin).
He goes on to give the recommendations of the Center for Disease
Control for the management of acute otitis media, which focus on the
antibiotics that have been found most effective:
In patients who have not otherwise had antibiotics in the last month,
the recommendation is to start with normal or high-dose (80-90
mg/kg/day) amoxicillin.
If there is no success by day 3, the next strategy is to try one out
of high-dose amoxicillin-clavulanate (Augmentin);cefuroxime axetil
(Ceftin); or intramuscular ceftriaxone (Rocephin). High-dose
amoxicillin-clavulanate is 80 to 90 mg/kg/day of amoxicillin, with 6.4
mg/kg/day of clavulanate. This usually means two prescriptions: one
for amoxicillin (40 mg per kg per day) and one for
amoxicillin-clavulanate (also at 40 mg per kg per day of
amoxicillin).. Intramuscular Rocephin has been shown to be effective
in resistant acute otitis media if given 3 times dailyfor 2-3 days.
However, this would presumably mean you would have to go a clinic 3
times daily to get the injections done.
If there is no success within 7-25 days (ie 10-28 days of starting all
treatment), the recommendation is to try another of the antibiotics
listed for day 3.
Patients who have otherwise had antibiotics in the last month need to
be started on high-dose amoxicillin; high-dose
amoxicillin-clavulanate; or cefuroxime axetil. If these do not work by
day 3, the next choice is one out of intramuscular ceftriaxone
(Rocephin); or clindamycin. However, clindamycin won’t be effective
if the bacteria responsible for the infection ar Haemophilus
influenzae or Moraxella catarrhalis. The next choice at days 10-28 is
one out of high-dose amoxicillin-clavulanate; cefuroxime axetil; or
intramuscular ceftriaxone (Rocephin), obviously selecting a treatment
that has not been used so far.
You mention that amoxicillin has not helped. It might be useful to
check the dose you were prescribed to see if it was a high dose or
not.
Although the antibiotics listed above are considered the most
effective, a number of others can also be used. For example, the
author mentions: “Two other antibiotics--cefprozil and cefpodoxime
(Vantin)--were strongly considered as empiric candidates but were not
included among the preferred choices because more data are needed.
Cefdinir (Omnicef), the newest antibiotic for acute otitis media, was
not labeled at the time of the CDC review.” Cefprozil is one that you
have already tried, namely Cefzil.
A further approach which the CDC puts forward for consideration is
tympanocentesis. This means withdrawing the fluid from behind the ear
drum and culturing it to try and identify which specific organism is
responsible and to test its responses to antibiotics. This allows the
choice of the antibiotic to be absolutely specific to the sensitivity
shown by that organism. However, the author points out that few
family doctors perform this procedure, so it is usually necessary to
find an otolaryngologist.
He has more to say about tympanocentesis in the article which precedes
this one: “Acute Otitis Media: Part I. Improving Diagnostic Accuracy”
http://www.aafp.org/afp/20000401/2051.html
The tympanocentesis may in itself help your symptoms: “Before the
discovery of antimicrobial agents, tympanocentesis was a common
procedure used not only by otolaryngologists but also by
pediatricians.This was often the only effective means of treating an
ear infection. The procedure allows for drainage of fluid from the
middle ear, and it provides immediate relief of symptoms such as pain,
irritability, and fever.” From: “Tympanocentesis in the Diagnosis and
Treatment of Otitis Media”, Published in INFECTIONS in MEDICINE, July
2001, Pgs. 363-366 by Itzhak Brook, MD, MSc, Georgetown University
School of Medicine, Washington, DC
http://www.omew.com/research/tdtom.htm
Other than trying the antibiotics discussed above and discussing the
option of tympanocentesis, you may wish to ask your doctor to
prescribe some stronger pain killers than the ones you have tried so
far. The condition will resolve eventually, with or without
antibiotics, so controlling the symptoms will also be a helpful
strategy.
You might also wish to consider taking supplements to boost your
immune system and help your body deal with the bacteria. Although
these are on the border of alternative medicine, you might wish to
consider taking vitamin C, zinc and echinacea for a week or two.
I wish you a speedy recovery from this unpleasant condition! |
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