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Acute otitis externa in children.

Colin J McWilliams¹, Christine H Smith, Ran D Goldman

¹BC Children's Hospital, Department of Pediatrics, Room K4-226, Ambulatory Care Bldg, 4480 Oak St, Vancouver, BC V6H 3V4.

Canadian Family Physician Medecin De Famille Canadien

|November 16, 2012

Summary

For uncomplicated acute otitis externa (AOE) in children, topical antibiotic-steroid preparations are recommended as first-line treatment. Oral antibiotics are not typically necessary for this common summer ear infection.

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Area of Science:

Otolaryngology
Pediatric Infectious Diseases
Pharmacology

Background:

Acute otitis externa (AOE) is frequently diagnosed in children during summer months.
Multiple topical ototopical preparations are available for treating AOE.
Current treatment guidelines for AOE vary, with a need for clarity on first-line agents.

Purpose of the Study:

To determine the optimal first-line treatment agent for uncomplicated acute otitis externa (AOE) in children.
To evaluate the role of oral antibiotics in the management of uncomplicated AOE.

Main Methods:

Review of current American guidelines for AOE management.
Analysis of a recent Cochrane review on ototopical therapies for AOE.
Consideration of clinical practice patterns in the absence of specific Canadian guidelines.

Main Results:

American guidelines advocate for initial ototopical therapy without systemic antibiotics for uncomplicated AOE.
Evidence suggests minimal differences among various ototopical preparations.
Antibiotic-steroid combination ototopical treatments demonstrate superiority over placebo or acetic acid for AOE resolution.

Conclusions:

Topical antibiotic-steroid formulations are recommended for 7 to 10 days for uncomplicated AOE.
The choice of specific ototopical agent should be guided by the clinical scenario.
Systemic antibiotics are generally not indicated for uncomplicated AOE.