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How can chronic ear infection be treated?

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Dr. Priyanka Aggarwal

ENT Specialist

Practicing since :2008

Answered : 1362 Questions

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Posted on Tue, 24 Apr 2018 in Ear, Nose and Throat Problems
Question: I have an ear infection that has been going on since 9/10/2017. Amoxicillin was totally ineffective, Amox-Clav the generic version of augmentin was slightly effective, 20 days of 875 mg one pill every 8 hours suppressed the infection but it came back as soon as I stopped. Cefdinir is pretty effective but I can't convince a doctor to give me enough for long enough to kill. I had 26, 300 mg, mostly one every 8 hours and I was symptom free for about one day, but as soon as I stopped the bug came back. Currently on cefdinir, but once again not enough or long enough - eight days at mostly one pill every 8 hours. Today I run out and still not symptom free. Ciprodex ear drops are highly effective but a layer of residue builds up in my ear and stops them from working. Extremely debilitated. Starting to worry that I might die. Infection came from a hot tub at the gym used by naked men. Suspect bacteria is an intestinal bacterial. I desperately need help. What I need is someone who can review this information and decide based on it what antibiotic will most likely work. I could use a first choice and a second choice. The normal ear infection protocols might not be effective since the source of the bacteria is a hot tub with naked men.
doctor
Answered by Dr. Priyanka Aggarwal 1 hour later
Brief Answer:
Ear infection

Detailed Answer:
Hi
Welcome to health care Magic and thanks for putting up the query.
Please tell me do you have any ear discharge also?
If there is ear discharge, my advise to you is you should get a culture sensitivity test done for the ear discharge to see the exact causative organism and the most effective antibiotics. It is always better to use a specific antibiotic that will completely clear the infection.
Secondly you should get the ear cleaned up by an Ent specialist so that medicines can work.
keep the ear dry and avoid swimming otherwise It is advisable to use ear plugs.

My advice will be to get these done and then try antibiotics.

Continue using ciprofloxacin ear drops.
Any further questions are always welcome.
Wishing you a speedy recovery.
Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Priyanka Aggarwal 48 minutes later
Dr. Aggarwal, my situation is way way beyond your advice. They tried to culture the infection but only after it have been treated with amoxicillin and niamcyn eardrops for over a mouth. No results. The ENT specialist also cleared out my ear. What I need from you is a recommendation for antibiotics. You or an infectious disease specialist should be able to review the information that I gave you and based on the sensitivity of the bacteria to the various antibiotics I told you about figure out which one is most likely to work. This infection should not be treated as a normal ear infection because the normal ear antibiotics don't work. You are way underestimating the seriousness of the situation. The basic principle is treating this kind of infection is, since it can't be cultured, you have to guess what might work and then try it. I can tell right away whether it is working. If it doesn't work, you have to make another guess and try that. The reason that I am asking you is because none of the doctors, NONE of the doctors, that I have spoken to about this have been able to help. They don't seem to know anything about antibiotics and how they work. They don't seem to know anything about antibiotics and how they work. I don't mean to insult you, but I don't think you do either, or you would not have given me that answer that you just did. Can you send my case to someone who does know about antibiotics, or if I am wrong about you, can you help me with your best guess about what I should try next. If you can suggest an antibiotic, with some confidence, I can go to urgent care and ask them to prescribe it. If you can't help me my next step is going to be to go the the Emergency room.

Repeat

Dr. Aggarwal, my situation is way way beyond your advice. They tried to culture the infection but only after it have been treated with amoxicillin and niamcyn eardrops for over a mouth. No results. The ENT specialist also cleared out my ear. What I need from you is a recommendation for antibiotics. You or an infectious disease specialist should be able to review the information that I gave you and based on the sensitivity of the bacteria to the various antibiotics I told you about figure out which one is most likely to work. This infection should not be treated as a normal ear infection because the normal ear antibiotics don't work. You are way underestimating the seriousness of the situation. The basic principle is treating this kind of infection is, since it can't be cultured, you have to guess what might work and then try it. I can tell right away whether it is working. If it doesn't work, you have to make another guess and try that. The reason that I am asking you is because none of the doctors, NONE of the doctors, that I have spoken to about this have been able to help. They don't seem to know anything about antibiotics and how they work. They don't seem to know anything about antibiotics and how they work. I don't mean to insult you, but I don't think you do either, or you would not have given me that answer that you just did. Can you send my case to someone who does know about antibiotics, or if I am wrong about you, can you help me with your best guess about what I should try next. If you can suggest an antibiotic, with some confidence, I can go to urgent care and ask them to prescribe it. If you can't help me my next step is going to be to go the the Emergency room.


doctor
Answered by Dr. Priyanka Aggarwal 8 hours later
Brief Answer:
Ear infection

Detailed Answer:
Hi
I would try my best to help you out.
As per the whole medication history I think you should take injection ceftriaxone 1g intravenous twice daily and tablet metronidazole thrice daily. Put gentamycin ear drops. Following this you will be under a complete gram positive, gram negative and anaerobic bacterial coverage.
You have to follow this for at least a week.
One more advise, if the bacteria is not being cultured it is better to go for a blood culture and a deep ear swab.
I hope my advise proves helpful.
Any further questions are always welcome.
Wishing you a speedy recovery.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Priyanka Aggarwal 12 hours later
Much better, thank you! But, my problem is more than just figuring out the right medicine, I am having a problem with doctors. My wife was a gifted psychotherapist with her own full practice. She died of pancreatic cancer in May. She took care of me and talked to the doctors when I needed help. I also lost my very good doctor that I had for over twenty years. He had 3000 patients. I am going to use your information to help me with finding an ENT specialist, which is going to take some time, maybe a week or more. Right now, I have been going to Urgent Care, that is a walk in place. They are actually pretty good but there is no way that they would follow your advice. They would insist that I go to a specialist. I have had discussions with them about zithromax or suprax as possibilities for a prescription until I can see a specialist. I might be able to talk them into a prescription for one of these. Do you think either of those might work? Also, since the bacteria was from a hot tub with bubbling water jets, it is very unlikely that it is anaerobic. What part of your medicines covers that? Again, thanks for you help.
doctor
Answered by Dr. Priyanka Aggarwal 24 hours later
Brief Answer:
Ear infection

Detailed Answer:
Hi
Suprax is a better option than zithromax.
Gut flora is heat sensitive and get killed by hit water.
I think you have encountered a mixed infection I.e. fungal and bacterial. so I would insist you to use candibiotic ear drops or ointment.

The antibiotic regime I mentioned before contains ceftriaxone that is effective against gut bacteria.

I hope my advise proves helpful to you

Take care
Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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