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Dr. Andrew Rynne

Family Physician

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How can chronic ear infection be treated?

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Dr. Salah Saad Shoman

Internal Medicine Specialist

Practicing since :2004

Answered : 1717 Questions

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Posted on Tue, 24 Apr 2018 in Medicines and Side Effects
Question: I need someone who is an expert with antibiotics. I have an infection that has been going on since 9/10/17. Amoxicillin is totally ineffective, Amox-clav is somewhat effective but 20 days would not completely kill the bacteria. Cefdinir is more effective, and probably would work with the right dose applied for long enough, 300 mg three times per day for at least 14 days. Can't get anyone to prescribe that dose for that long. The infection came from a hot tub used by naked men. My question is what antibiotic would you recommend next?
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Answered by Dr. Salah Saad Shoman 1 hour later
Brief Answer:
Depend on the site of infection

Detailed Answer:
Dear sir, I have gone through your question and I understand your concerns but the choice of an antibiotic depends on the site infection which I would like you to clarify .. for example doxycycline is used to treat middle ear or sinus infection while metronidazole is used to treat skin , stomach and respiratory infections and so on..
Also if you have tried two types of antibiotics that have not been effective in clearing the infection then I would recommend that you get a culture followed by a culture and sensitivity test to detect which antibiotic your infection is sensitive to and for how long you should be receiving it.. I hope you find this helpful..
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Salah Saad Shoman 4 hours later
It is an ear infection and it can't be cultured because it has been treated so much already that a culture was ineffective. The concept that I am asking about is to use the information that I have given you about how effective the antibiotics are that have already been tried to guess what other antibiotic would be effective. For example, no antibiotic from the penicillin family is going to work at all. Also considering the source of the infection, a hot tub with naked men, as a possible indicator. If you had to choose between zithromax, suprax, or doxycycline which would you choose? That is three different antibiotics from three different families. doxycycline is related to zithromax so my take on that is that zithromax might work just as well. Since suprax is in the same family as cefdinir and the bacteria is moderately susceptible to cefdinir, the suprax could be a good choice. My point is that someone who really understands antibiotics would know how to judge this situation. That is the expert that I want. But if all you can give me is your best guess, I'll take that. Again, let me repeat a simple concept that no doctor that I have talked with seems to understand. You take your best guess about which antibiotic will work. I try that. I can tell right a way how effective the antibiotic is by my reaction to it. The right antibiotic is dramatically effective. If the antibiotic doesn't work, you try the next one. I can tell how effective that is. That is the only way to tell. Most doctors won't do that. They would rather have their patient suffer than make a mistake or challenge their ego. YOU don't have to worry about that because you are not going to be writing a prescription. Please consult with your colleagues and do some research and give me your best, educated guess. Thank you. Again, the answer I want is the best two antibiotics that you think might work.
doctor
Answered by Dr. Salah Saad Shoman 21 hours later
Brief Answer:
Pseudomonas aeruginosa

Detailed Answer:
Dear sir, hello again.. considering the source and site of infection the causative organism is probably pseudomonas aeruginosa which is usually resistant to penicillins , aminoglycosides and betalactams ..
This is why I would recommend the use of ciprofloxacin or a third generation cephalosporin as Suprax or ceftazidime.. I hope you find this helpful ..
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Salah Saad Shoman 2 hours later
That is extremely helpful to me. Thank you very much!
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Answered by Dr. Salah Saad Shoman 10 hours later
Brief Answer:
You are welcome

Detailed Answer:
you are welcome , kind regards.. If you don't have any other clarifications then please close the discussion and rate the answer..
Above answer was peer-reviewed by : Dr. Kampana
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