What is an Ear Infection, and How Does it Develop?
An ear infection, or otitis media, is an inflammation of the middle ear. It can be caused by bacteria or viruses. Otitis media is especially common in children. During childhood, about 8 in 10 children will develop this condition, with most of the cases occurring in the first 3 years of life [1, 2, 3].
The pathogenesis of ear infections often involves the occlusion of the eustachian tube, a small canal between the ear and the throat. When its lumen is blocked, fluid can build up in the middle part of the ear, giving a substrate for the pathogens to grow on. Usually, the obstruction occurs during colds, sinusitis, or allergies [1, 4].
Another reason for an ear infection can be the spreading of the causative agent from an infected adenoid close to the Eustachian tube [1].
Early in life, the eustachian canal is quite short and narrow. This is the direct cause of the high prevalence of otitis media in children. An additional increase in the risk of ear infection is caused by bottle-fed babies. When a baby lies flat, the channel between the throat and the ear is more likely to get obstructed with the milk formula [5].
Other risk factors for otitis media are:
- altitude changes,
- changes in temperature and humidity,
- cigarette smoke,
- male sex,
- low birth weight [1]
What are the Symptoms of an Ear Infection?
Depending on the type and severity of the infection, otitis can have many manifestations.
A common symptom is pain inside the ear. It can be experienced along with a persistent feeling of increased pressure in the ear [1].
During an infection, fluid discharge can also be seen. The solution can accumulate in the ear, leading to obstruction of the ear canal. This can restrict the hearing [1].
Additionally, ear infections can cause headaches, nausea, problems with imbalance, or dizziness [5].
In some cases, particularly when the infection is severe, systemic symptoms can also be present. They include severe pain and fever [1].
Babies with otitis can be observed to lose appetite, become restless, and pull or manipulate around the ear [1]. In some cases, they can also experience diarrhea and vomiting [6].
What is azithromycin, and how does it work?
Azithromycin belongs to macrolides, a group of bacteriostatic antibiotics. This means that it stops bacterial proliferation and multiplication. It does so by inhibiting bacterial protein synthesis.
Azithromycin can be used in the treatment of various types of infections, among which are ear infections. It is an antibiotic that works effectively against bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis [8, 9, 10, 7, 11, 12].
Azithromycin has shown effectiveness in treating acute otitis media in children. In one study, 98% of azithromycin treated patients showed cure or improvement in signs and symptoms.
Who Should Take Azithromycin For an Ear Infection?
As azithromycin is an antibiotic, it should be taken only for bacterial infections. To be sure that the otitis is of bacterial origin, it is best to consult a doctor who can confirm the suspicion and prescribe the medication.
This macrolide is a perfect choice for anyone who does not like to take tablets for a long time. It has special pharmacological properties, which allow Azithromicyn to be taken for three or fewer days. Even a single dosage of this drug achieves therapeutic concentrations and can be very effective [8, 9, 10, 13, 7, 11, 12].
However, it's important to remember that azithromycin should only be used when prescribed by a doctor. Frequent or long-term use can lead to antibiotic resistance. Additionally, while azithromycin is generally well-tolerated, inappropriate use can increase the toxic effect and lead to serious side effects [14, 15].
What are the side effects of Azithromycin for ear infection?
Azithromycin is an overall well-tolerated antibiotic for ear infections. However, like all medications, it can have potential risks and side effects.
One potential side effect linked to azithromycin is its ototoxicity. Treatment with azithromycin can lead to sensorineural hearing loss (SNHL). Some studies have reported that even at lower doses, this antibiotic can lead to irreversible SNHL [15, 16]. However, large-scale studies, including thousands of patients, indicated that the incidence of SNHL with short-term use of azithromycin is lower than 1% [14].
A general factor of risk in all antibiotic treatments is the potential development of resistant bacteria. Long-term use of azithromycin can increase these risks, leading to less effective treatment [17].
Long-lasting use of azithromycin can also lead to heart problems. It can cause a prolonged QT interval, which can lead to a disturbance in the electric activity of the cardiac muscle. A longer QT interval can provoke arrhythmias like ventricular re-entry tachycardias. This type of dysrhythmia can be dangerous and even cause death.
A small study on patients with chronic obstructive pulmonary disease showed that 3 out of 10 experienced QT prolongation [18].