EARS - Otitis Externa, Malignant (Pseudomonas aeruginosa)

  Comment: Consider urgent ENT, infectious disease consult. Only early, very mild cases appropriate for outpatient therapy. Assess need for IV antibiotics. Usually occurs in diabetic patients.                                                                                                              

 

Ciprofloxacin

(Cipro®)

Pregnancy: C; Lactation: Unsafe

 

 

Tabs: 250 mg, 500 mg, 750 mg   

 

Adult: 750 mg PO twice daily for 7-14 days.

 

Food: Take 1 hour before or 2 hours after a meal. May take with food if it causes GI upset. Make take 2 hours before or 6 hours after sucralfate, antacids, aluminum, magnesium, calcium, zinc, iron, vitamins, or mineral supplements.

 

 

Important side effects: Photosensitivity, dizziness.

 

Reduce dose in renal disease (CrCl <50 mL/min).

 

 

Levofloxacin

(Levaquin®)

Pregnancy: C; Lactation: Unsafe

 

 

Tabs: 250 mg, 500 mg     

 

Adult: 500 mg PO once daily for 7-14 days.

 

Food: Do not take within 2 hours of antacids, magnesium, calcium, zinc, iron, aluminum, sucralfate, vitamins, or mineral supplements.

 

 

Important side effects: Photosensitivity, dizziness.

 

Reduce dose in renal disease (CrCl <50 mL/min).

 

 

Imipenem/cilastatin IV

(Primaxin®)

 

Pregnancy: C; Lactation: Unk

 

 

 

Other IV drug with good antipseudomonal coverage.

 

Examples include ciprofloxacin, ceftazidime, or a combination of an aminoglycoside and piperacillin.

 

 

Adult: 500 mg IV every 6 hours. 7-14 days (or until switch to alternate oral agent is appropriate).

 

Important side effects: Confusion, seizures.