Choice #1: Clementine
Otitis media and otitis externa form common ear infections associated with the upper respiratory tract. Otitis media manifests as acute otitis media (AOM) marked by inflammations in the middle ear mucosal lining and middle ear fluid. Though infrequent in adults compared to children, otitis media’s pathophysiology involves polymorphisms in immunoresponse genes and proinflammatory cytokine genes (Klein et al., 2015). Otitis externa involves infections to the external auditory canal’s cutis and subcutis associated with the pinna and tympanic membrane. The condition predominantly affects adults than children, with its pathogenesis related to anatomical factors, skin diseases, environmental factors, systemic diseases like diabetes, and trauma.
In Clementine’s case, establishing a proper diagnosis for otitis media will warrant establishing a treatment plan to treat infectious processes with antibiotics. As stated by Woo and Robinson (2020), the pathogens in AOM can be bacterial or viral. The treatment is the use of antibiotics to clear the infection from the middle ear fluid. Woo and Robinson (2020) state that “if treatment with an antibiotic, amoxicillin is the first choice for most children if they have not received amoxicillin in the last 30 days” (p. 1328). The dosing for amoxicillin is 80 to 90 mg/kg/d. Allergies should also be taken into consideration, and those with penicillin allergy may be treated with cefdinir (14 mg/kg/d), cefuroxime (30mg/kg/d divided bid), cefpodoxime (10 mg/kg/d divided bid), or ceftriaxone (50mg/d IM or IV for 1-3 days) (Woo & Robinson, 2020). Length of treatment is usually 10 days with antibiotics. In addition to antibiotics, pain relief can be provided with the use of acetaminophen 15 mg/kg per dose or ibuprofen 5-10 mg/kg per dose (Woo & Robinson, 2020).
Looking into otitis externa, or swimmer’s ear, Woo and Robinson (2020) contend the treatment of otitis externa includes combination products of corticosteroid (Cortisporin) and antibiotics (neomycin, polymyxin B, ciprofloxacin), antibiotic alone (gentamicin, ofloxacin), and acetic acid or alcohol drops. Clementine’s first approach to treatment will involve “antibiotic/steroid eardrops, which combine an antibiotic(s) and an anti-inflammatory such as neomycin sulfate, polymyxin B, and hydrocortisone; ciprofloxacin and hydrocortisone; or ciprofloxacin and dexamethasone” (Woo & Robinson, 2020, p. 1331). Routine dosing is 3-4 drops administered 4 times a day. As with otitis media, otitis externa pain can be relieved with use of NSAIDs. Symptom and pain relief should be seen in 3-4 days and reevaluation should be done in 1 week.
During treatment, Clementine requires critical patient education to manage or prevent any recurrence of otitis media and otitis externa infections. As with the prescribing and use of any medication, the provider should provide clear teaching on proper use of the prescribed antibiotic including dosage and timing of doses. Additionally, it is important to discuss expected side effects such as mild diarrhea that commonly occur with the use of antibiotics (Hum et al., 2019). Most importantly, course of antibiotics should be completed entirely in the time frame and not discontinued based on symptom relief. In the case of swimmer’s ear, patient should be educated to avoid pooling or accumulation of water in the ear canal and, if encountered, should be eliminated by instilling 3-4 drops of 1:1 solution of water and white vinegar or 70% ethyl alcohol (Woo & Robinson, 2020).
Hum, S. W., Shaikh, K. J., Musa, S. S., & Shaikh, N. (2019). Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. The Journal of Pediatrics, 215, 139–143. https://doi.org/10.1016/j.jpeds.2019.08.043
Klein, J. O. (2015). Otitis externa, otitis media, and mastoiditis. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 1, 767-773. doi: 10.1016/B978-1-4557-4801-3.00062-X
Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th ed.). F.A. Davis Company.
Choice #1: Clementine