Allergic To Penicillin: What To Use For An Ear Infection

Hello and thank you for your question!

We're more than happy to provide some guidance here for you.

First-Line Recommendations

The first consideration here, appropriate antibiotics for an ear infection, is the type of ear infection you have (e.g. middle ear infection, external ear infection, etc...) as treatment choice depends on this.

Fortunately, you mentioned in your question that you have a middle ear infection.

Most medical guidelines, including the guidelines published by the American Academy of Pediatrics, recommend amoxicillin or amoxicillin-clavulanate for initial treatment. This applies to adults as well.

If amoxicillin is a good choice for you, the exact therapy your doctor prescribes, including the dose you are taking and how long you are taking it for, depends on a few factors, including:

• Type of bacteria causing the infection
• Whether or not your geographical location has a high prevalence of resistant bacteria
• Whether or not you have a history of ear infections
• Whether or not you have an intact tympanic membrane

Now, you asked this question because you are allergic to penicillin. Amoxicillin is very much in the penicillin family, so, if you do have a true allergy to it, alternative antibiotics would be needed.

Penicillin Allergy Alternative Antibiotics

With penicillin and penicillin-type antibiotics (like amoxicillin) off the table, there are several other options you and your doctor can consider.

The first consideration here is how bad your allergy to penicillin actually is.

Mild Reactions To Penicillin-Type Antibiotics

If you have a somewhat mild reaction, which typically is in the form of a minor skin rash or other non-severe symptoms (like significant swelling, trouble breathing, etc), drugs in the cephalosporin class are an option.

Cephalosporins are related to penicillin drugs in that they share similar chemical structures.

There is a little bit of controversy in regard to how safe cephalosporins are in those with a penicillin allergy, as studies show there is some cross-reactivity between the two (i.e. if you are allergic to penicillins, you have a higher risk of being allergic to cephalosporins).

Nevertheless, as mentioned above, if you have had a relatively minor reaction to penicillin, your doctor may decide to go with a cephalosporin. These drug options include:

• Cefdinir
• Cefpodoxime
• Cefuroxime

Major Reactions To Penicillin-Type Antibiotics

Fortunately, there are several other options that are available to you. These alternative antibiotics include:

• Azithromycin
• Clarithromycin
• Clindamycin

In addition, sometimes trimethoprim-sulfamethoxazole (generic Bactrim) can be used as a penicillin alternative for middle ear infections, but it can only be used in geographic locations where pneumococcal resistance is not a concern.

What About Ear Drops?

There are several antibiotics available in a topical 'eardrop' form, and many of these antibiotics are combined with steroids for pain relief. These drug options include:

• Ciprofloxacin
• Ciprofloxacin/dexamethasone
• Cortisporin
• Neomycin/polymyxin/hydrocortisone

In the vast majority of cases, ear drop antibiotics should not be used if you have a middle ear infection as they won't be effective since they can't reach the site of infection.

Eardrop antibiotics are only really useful when you have otitis externa, which is an infection of the outer ear and outer ear canal.

If you do have otitis externa, topical ear drops are a great choice, and typically provide very fast relief. However, as stated, they won't do much good with a middle ear infection.

There is a caveat to this though.

Some antibiotic ear drops can be used if you have a tympanic membrane perforation or you have ear tubes (tympanostomy), since both situations allow the antibiotic to reach the site of infection.

You did mention in your question that you had a perforated eardrum. As mentioned, antibiotic eardrops can be used in this situation, but most guidelines still recommend going with oral options first since a perforation can heal quickly, limiting the exposure the drops will get to the infection.

Lastly, you asked about Cortisporin HC ear suspension. Cortisporin contains neomycin, which should not be used if you have a perforated eardrum due to the risk of toxicity. Other ear drops, like ciprofloxacin, would be preferred.

Final Words

Thanks again for your question. I hope this answer helped!