Anaesthetic And An Analgesic Ear Drops Can Be Considered For Acute Otitis Media To Reduce Antibiotic Use


NICE has issued an update on acute otitis media (ear infection) guideline.

Acute otitis media (AOM) is an infection of the middle ear that causes inflammation and a build-up of fluid behind the eardrum. It can be caused by viruses or bacteria. Anyone can develop a middle ear infection, but it is most common in children up to five-years-old.

NICE issued its first guideline in acute ear infections in 2018, which said most common ear infections should not be treated with antibiotics as most children and young people get better within three days without antibiotics. Treatment options include pain relief with oral analgesics with the option of a back-up antibiotic prescription. Immediate antibiotics are an option in those most likely to benefit from an antibiotic (those of any age with ear discharge or those under 2 years with infection in both ears).

In the recent update, released, NICE is recommending health professionals and the families and carers of children and young people with acute otitis media consider using ear drops containing an anaesthetic and an analgesic for pain associated with AOM. This approach aims to further reduce the over-use of antibiotics for this common ear infection.

The anaesthetic and an analgesic ear drops can be used if an immediate antibiotic prescription is not given and there is no ear drum perforation or otorrhoea (discharge from the ear). Currently in England, there is one preparation of anaesthetic/analgesic ear drops available – Otigo.

The anaesthetic and an analgesic ear drops are available on prescription with four drops being applied two or three times a day for up to a week. 

There are around 896,000 episodes of AOM in children aged 0 to 5 years old in England each year. Of these, 524,000 are estimated to have AOM with no ear drum perforation or otorrhoea and are eligible for pain treatment with ear drops containing an anaesthetic and an analgesic.

Currently paracetamol or ibuprofen are routinely used to manage pain associated with AOM and there is very minimal use of ear drops containing an anaesthetic and an analgesic.

Dr Paul Chrisp, director of NICE’s centre for guidelines, said: “Based on evidence, our committee agreed that ear drops containing an anaesthetic and an analgesic may reduce antibiotic consumption and relieve pain in children who did not need immediate antibiotics.

“The evidence shows antibiotics are not needed by most children and young people with middle ear infections. We must make sure the people who need them are given them, but routine prescribing in all cases isn’t appropriate.

“We will continue to monitor new studies or treatments, which could be relevant to and impact on our guidelines to ensure that our advice and information remains as up to date as possible.”

NICE’s guideline sets out an antimicrobial prescribing strategy for AOM which aims to limit antibiotic use and reduce antimicrobial resistance, which includes a visual summary of the recommendations on treating acute otitis media.

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