OTC cases: ear infections

OTC cases: ear infections

Q: PJ is a 7 year old boy with complaints of ringing in the ears followed by hearing problems with sudden onset. Her mother, ET, reported that he had a cold last week and that he appears to have poor balance when he walks. He asks for wax removal kits to improve hearing problems. What should the pharmacist recommend?

A: Symptoms of PJ are consistent with the common presentation of labyrinthitis and the pharmacist should refer him to his PCP for further evaluation and treatment. Symptoms of hearing loss and poor balance, especially in a child with a recent cold, suggest a viral etiology. Viral infections are a common trigger for labyrinthitis. PJ’s PCP can conduct tests and refer the child to a specialist. In some cases, corticosteroids or antiviral drugs may be prescribed.1.2

Q: MT, a 42-year-old man, has a prescription for ciprofloxacin and dexamethasone (Ciprodex). He hasn’t used ear drops since he was a child and his mother pulled his ear canal down to apply the treatments. MT asks the pharmacist to guide him through the adult app. How should the pharmacist instruct him on the use of the drug?

A: MT should first wash their hands with soap and water. It should then warm up
the bottle of ciprofloxacin and dexamethasone in your hands for 1 to 2 minutes before administration, as dizziness may occur if a suspension of cold otic is instilled into the ear canal. The pharmacist should then instruct MT to remove the cap and place it on a clean, dry surface. Unlike how children are given eye drops, TM should tilt their head to the side and pull the affected ear up and back. He should then administer the ear drops using the applicator, but prevent the applicator tip from entering the ear canal. To maximize exposure to ciprofloxacin and dexamethasone, she should lie on her side with the affected ear facing up for 5 minutes or place a cotton ball on the end of the external ear canal of the affected ear for 20 minutes. Remind MT not to share this drug with others.3

Q: JP is a 35-pound 3-year-old with mild to moderate ear pain who has had a fever of 38 ° C in the past 24 hours. His mother, MO, calls the pharmacy with questions about one-sided AOM. She noted that after the consultation, JP’s pediatrician recommended the initial observation with pain control but no antibiotics. MO is concerned about the pediatrician’s recommendation and asks for the pharmacist’s input and what pain medications JP should take. What advice can the pharmacist give you?

A: Given that JP is an immunocompetent child over 2 years of age with no craniofacial abnormalities and ear discharge and with a temperature below 39 ° C, the study results support the immediate antibiotic treatment or initial observation approach. If pain and symptoms worsen or do not improve after 48 to 72 hours, the pediatrician should administer JP antibiotics. Typically, a pediatrician will choose an antibiotic treatment with amoxicillin or amoxicillin-clavulanate for AOM if no recent allergies, antibiotic use, or resistance are noted. If your JP symptoms improve in 48 hours, you should follow up with your pediatrician at your next health maintenance visit.4-9

In terms of pain control, the study results show that AOM patients who received acetaminophen or ibuprofen experienced pain relief at 48 hours compared to a placebo. There are insufficient data to support the combined use of acetaminophen and ibuprofen. If using acetaminophen, administer 160 mg of oral liquid every 4-6 hours as needed, with a maximum of 5 doses per day and a maximum daily dose of 75 mg / kg or 4000 mg, whichever is lower. If using ibuprofen, administer 100 mg of oral liquid every 6 to 8 hours, with a maximum single dose of 400 mg and a maximum daily dose of 40 mg / kg per day.10.11

Q: HP is a 68-year-old man asking about a non-prescription product to help with painful, waterlogged ears with discharge. He has just returned from a family trip to an all-inclusive beach resort, where he spent most of his time in the pool. HP’s temperature has risen in the last 2 days since his return and he is hard of hearing on the phone, which is a necessity for his work from home. Her colleague said the over-the-counter ear drops relieve discomfort. What advice should the pharmacist give to HP?

A: Symptoms of discharge, ear pain and fever, combined with a lot of time swimming recently, are consistent with the common presentation of swimmer’s ear. Given the virulent nature of swimmer’s ear, refer HP to its primary care provider (PCP) for further evaluation and treatment. In the meantime, HP should be instructed to avoid using cotton swabs. The PCP will likely first clean HP’s ear canal using an otoscope and then treat the infection and inflammation with a topical steroid and / or an oral or topical antibiotic. The PCP may recommend an over-the-counter pain reliever such as ibuprofen or naproxen to treat ear pain. Throughout the duration of swimmer’s ear treatment, HP should protect his ears from water by using petroleum jelly-coated cotton balls while bathing and avoid swimming for 7-10 days.12.13

If HP had water clogged ears with no leaks, fever or pain, he could have self-treated with an earwax removal kit, such as carbamide peroxide. To reduce the risk of swimmer’s ear in the future, he should use earplugs when swimming and, if water gets into his ears, tilt his head to each side to shake his ears. HP may also consider blow drying your ears at the lowest temperature after exposure to water, keeping the hair dryer 1 foot away from your ears.14

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitional clinical pharmacist at Morristown Medical Center in New Jersey.

Ammie J. Patel, PharmD, BCPS, BCACP, is Assistant Clinical Professor of Pharmacy Practice and Administration at Rutgers Ernest Mario School of Pharmacy, The State University of New Jersey in Piscataway and Outpatient Care Specialist at RWJ Barnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.


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