Saturday, May 26, 2012

Otic Medications


·         Kills or inhibits the growth of susceptible bacteria
·         Indication:
o    To dry the ear and kill susceptible bacteria
o    Acetic acid may be used to dry the ear.

acetic acid and aluminum acetate (Otic Domebro®)
amoxicillin (Amoxil®)
ampicillin trihydrate (Polycillin®)
cefaclor (Ceclor®)
chloramphenicol (Chloromycetin® otic)
clarithromycin (Biaxin®)
clindamycin hydrochloride (Cleocin®)
erythromycn (Ilotycin®, E-Mycin®)
gentamicin sulfate otic solution (Garamyin®)
loracarbef (Lorabid®)
penicillin V potassium (Pen-V®)
polymyxin B sulfate (Aerosporin®)
tetracycline hydrochloride (Achromycin®)
trimehoprim and sulfamethoxasole (Bactrim®, Cotri®, and Septra®)

Side Effects:

·         Mild diarrhea
·         Headache
·         Superinfection in patients with overgrowth of nonsusceptible organisms


·         Stimulate adrenergic receptors of respiratory mucosa, producing vasoconstriction and reducing respiratory tissue hyperemia to open Eustachian tube
·         Indication:
o    Adjunctive therapy for otitis media; to reduce respiratory congestion or open obstructed Eustachian tube

brompheniramine (Bromphen®,Dimetane®)
cetirizine (Zyrtec®)
chlorpheniramine (Chlor-Trimeton®, Teldrin®)
clemastine (Tavist®)
naphazoline hydrochloride (Allerest®, Albalon®)
tripolidine and pseudoephedrine (Actifed®)

Side Effects:

·         Drowsiness
·         Blurred vision
·         Dry mucus membranes


·         Block nerve conduction at or near application site to control pain associated with ear infections.
·         Indication:
o    To treat pain associated with ear infection

antipyrene and benzocaine combination (Auralgan® otic solution)
benzocaine (Tympagesic®)

Side Effects:

·         Irritation
·         Allergic reactions
·         May mask the symptoms of middle ear infection


·         Emulsify and loosen cerumen deposits
·         Indication:
o    To remove excess cerumen

carbamide peroxide (Debrox®)
boric Acid (Ear Dry®)
trolamine polypeptide oleate-condensate (Cerumenex®)

Side Effects:

·         Irritation, redness or swelling of the ear canal

General Contraindications and Precautions for Otic Medications:

o    Hypersensitivity reactions
§  Redness
§  Burning
§  Itching
§  Stinging
§  Vesicular or maculopapular dermatitis
§  Swelling and mild irritation
o    Perforated eardrums

General Nursing Interventions:

ü  Assess the patient for hearing loss, pain and ear drainage.
ü  Use the correct method to instill medications:

Ear drops:
o    Use clean technique; if tympanic membrane is damaged, use sterile technique.
o    Assist patient to side-lying position, ear being medicated uppermost.
o    Clean the pinna of the ear and the opening of the external ear canal with solution and cotton-tipped applicators as needed.
o    Warm the medication container with your hand or in warm water for comfort; partially fill the ear dropper with medication.
o    Straighten the auditory canal by:
§  For the child younger than age 3: pull the pinna/auricle down and back
§  For the adult and older child: pull the pinna up and back
o    Hold the bottle or dropper ½ inch above the ear canal and instill the correct number of drops along the side of the ear canal.
o    Apply gentle pressure with fingers to the tragus of the ear (to enhance the flow of medication to the ear canal).
o    Have the patient maintain side-lying position for 2-5 minutes for even dispersion.
o    Before the patient arises, loosely place a cotton ball at the meatus and leave in place for 30 mins. to prevent mediation loss.

Otic irrigation:
o    Assist the patient to a sitting or lying position with the head tilted toward the affected ear ; place water-proof pad and drainage receptacle under the affected ear.
o    Check that the temperature of the irrigant is 98ºF.
o    Determine that the tympanic membrane is intact before beginning the otic irrigation.
o    Straighten the ear canal and gently insert the syringe tip into the auditory meatus; direct the solution slowly and steadily along the wall of the canal (*to avoid damaging the tympanic membrane).
o    Use no more than 50 to 70 ml at one time.
o    Dry the outside of the ear with cotton balls after the solution drains. Place a dry cotton ball in the auditory meatus lightly to absorb remaining excess fluid.
o    Assist the patient to a side-lying position on the affected side for further drainage.
o    Assess for discomfort.

Administration of Ceruminolytics:
o    Moisten a cotton ball with medication before insertion. Do not use a swab because it might cause trauma to the inner ear.
o    Avoid touching ear with dropper.
o    Flush ear gently with warm water, using a soft rubber bulb ear syringe within 30 mins. after instillation to remove cerumen.
o    Keep container tightly closed and away from moisture.

ü  Assess the patient for hypersensitivity reactions. 

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