Ciprofloxacin....a Poor Prescription?

[sleepyjohn]

Two days ago I went to the Ram in CM with an ear problem. After an earache free life I have had several recurrences over several months. Moderate discomfort and considerable swelling in the left side canal and noticeable when chewing. In a previous episode it may have caused an ache along the line (forgotten the name) where skull plates join above the ear. Each time it has cleared itself up symptomwise.

The doctor washed out my ears, telling me an infection was less likely to hold in a clean ear (although I'm not sure how that gels with wax being antimicrobial).

He sent me off with a prescription for ciprofloxacin, a fluoroquinolone.

As antibiotics often work fast and no improvement in 48 hours I looked up Wiki.

I read that because of various factors this a drug of last resort.

In the adult population ciprofloxacin is limited to the treatment of proven serious and life threatening bacterial infections

and

Normally ciprofloxacin should only be used in patients who have failed at least one prior therapy. Reserved for the use in patients who are seriously ill and may soon require immediate hospitalization

I went on to look at appropriate conditions but ear canal was not one of them.

The nearest was sinusitis which I guess is about internal narrow tubes like the ear, but:

Antibiotics do not improve sinusitis symptoms a number of studies have shown. Primary care physicians (family doctors) commonly prescribe ciprofloxacin to treat acute maxillary sinusitis (inflamed membranes of the sinuses), although there is no evidence that this approach is effective. A report in the British medical Journal the Lancet found that antibiotics did nothing more than the placebos used as the control.[152]

(my bolding)

Within a recent study concerning the proper use of this class in the emergency room it was revealed that 99% of these prescriptions were in error. Out of the one hundred total patients studied, eighty one received a fluoroquinolone for an inappropriate indication.

So is this a billion $ drug which I shouldn't be taking.

And what are the alternatives?

cheers John

[joskydive]

How to Treat an Ear Canal Infection

By eHow Health Editor

Rate: (6 Ratings)

Ear canal infections are one of the most common maladies one can experience. Symptoms are generally defined as intense pain in one or both ears. Luckily, ear canal infections are easy to treat through oral and topical medications.

The most common type of prescription medication to treat ear infections is Amoxicillin.

They also say to either add garlic to your daily diet or take deodorised Garlic pills.

[FBN]

SJ,

Not enough clinical info about symptoms to offer specific advice.

The pain alone is not an indication of infection. Usually fever, headache and perhaps swelling of the regional glands in the upper neck area are associated.

Distinction also needs to be made wether this is a middle ear problem or an otitis externa (ear canal).

Otitis media in an adult is rare so it is more likely to be an otitis externa. This is usually a localised infection and better treated with local application of antibiotic ear drops etc.

What was the final diagnosis? Was there significant pain when the doc cleaned out the ear and how was that done?

Cleaning the ear canal is indicated when there is dead or infected tissue or pus collection in the outer ear canal. Definitely not indicated when a middle ear infection is suspected or when there is an ear drum perforation.

Cipro is very much abused all over India, SEA and has resulted in many bugs such as Typhoid becoming resistent to this. The advantage here is that Cipro does achieve fairly high concentrations in soft tissues but the indications must be very clear.

Best if a swab is taken from the infected area and cultured to determine the correct antibiotic to use.

A second opinion may be called for here.

[Old Man River]

Antibiotics, based on doctors I have talked to, take 3 days before they take hold. Since your post is dated today, and you say only 2 days have passed, I would wait a few days before getting worried. Take the medicine for the amount of days prescribed and if still not much improved, then either go back to the same doctor or another one.

[BAYBOY]

Some years ago in New Zealand, I had a very bad case of athletes foot. Used to get a dose every couple of years but usually it went away with creams and foot powder. This time really bad and spread from the toes to the sole of my foot. Couldn't wear shoes so used slippers, and had trouble walking short distances and standing for periods.

.Saw the Doctor ,tried several antibiotics no improvement at all.

Then the skin started to peel away, all soft and smelt awful.... like rotting meat.Bathing my feet would remove strips of skin. I could smell it even when standing.Now very painful.

Doctor very worried as swabs had been taken and antibotics changed and still no improvement.He told my chemist that I could be looking at amputation of the foot as he was concerned it could spread and travel into my leg.He told me as a last resort to try Ciprofloxacin 500mg tablets, 2 a day till finished, 10 days of treatment

Slight improvement after 3 days, then 3 days further had cleared up and new skin growing, and it has never returned.

Living here in Thailand I get the odd case of itichy crutch and a rash. Use Ciprofloxin 500 mg for 2/3 days and it seems to just fade away.My Doctor had told me that moist damp parts of the body such as between toes and the crutch are breeding grounds for real nasties.

The other thing I was told that when taking Ciprofloxin avoid antacids, iron, and calcium. Also protect yourself from too much sunlight.

Easy to buy here blister pack of 10 tablets about 80 baht.

BAYBOY

[kyb789]

I have had ear infections my whole life. They come and go every year. I can tell you that they are dangerous if left untreated. I have hearing damage because I didn't always take it seriously. In general, Cipro is prescribed for lower body problems (e.g., intestinal, etc), as well as lung infections. Amoxicillin is prescribed for upper body infections (ears, nose, throat, etc).

I am surprised your doctor gave you Cipro for an ear infection. It is a strong antibiotic and you are correct that it should be taken taken when all else fails. Antibiotics are the best cure, so I recommend you take it until you are better. Just make sure you go the right one.

[sleepyjohn]

Thankyou all for all the input.

I should say I'm not particularly bothered about my particular case of ear infection although it's slightly disturbing to read what I read about no evidence of efficacy in sinusitis and no recommendation at all for ears.

I have become rather interested though in how doctors in places like Thailand, once they are qualified, get their information about new or improved methods of treatment, and in this case, pharmaceuticals.

Can anyone fill me in?

cheers....

[Emeritus]

...I have become rather interested though in how doctors in places like Thailand, once they are qualified, get their information about new or improved methods of treatment, and in this case, pharmaceuticals...

The salesmen (medical representatives) of pharmaceutical companies or importers/distributors talk the doctors into prescribing/selling the latest, most expensive products.

[sleepyjohn]

...I have become rather interested though in how doctors in places like Thailand, once they are qualified, get their information about new or improved methods of treatment, and in this case, pharmaceuticals...

The salesmen (medical representatives) of pharmaceutical companies or importers/distributors talk the doctors into prescribing/selling the latest, most expensive products.

That's the obvious assumption. I wonder though how much fact there is in it and/or whether there is some systematised educational update thing. There certainly should be. I would like to think my treatment was evidence-based.

cheers John

[sleepyjohn]

Well it's now two or three weeks after the course of CIPRO.

To remind readers I was questioning the judgement of prescribing something not recommended for ears and shown in Lancet to be useless for the next nearest narrow channel in the head type thing, sinusitis. (My ears were also cleaned BTW).

So 2 or 3 weeks later I am still noticing a feeling in my left ear which feels as if the canal is kind of a bit closed, like the sides are occasionally touching or something. No pain as such, but something's not right.

The question is: Do I go to the same doctor? Was it in fact a reasonable treatment?

Edited July 4, 2009 by sleepyjohn

[TerryLH]

"Use Ciprofloxin 500 mg for 2/3 days..."

I believe the normal course for antibiotics is longer than 2-3 days. Be using it this way you are taking a chance that eventually the drug will no longer work for you.

[Serpico]

...I have become rather interested though in how doctors in places like Thailand, once they are qualified, get their information about new or improved methods of treatment, and in this case, pharmaceuticals...

The salesmen (medical representatives) of pharmaceutical companies or importers/distributors talk the doctors into prescribing/selling the latest, most expensive products.

Yes, Doctors get free stuff if they sell enough product, free holidays, etc..

This should be illegal.

Same thing with suppliers selling crop chemicals to farmers. The chemical supply house will recommend high rates of applications and close intervals.

The chemical salesman will give away lots of free stuff if the farmer use enough chemicals.

[cyborg22]

Yes, Doctors get free stuff if they sell enough product, free holidays, etc..

This should be illegal.

Same thing with suppliers selling crop chemicals to farmers. The chemical supply house will recommend high rates of applications and close intervals.

The chemical salesman will give away lots of free stuff if the farmer use enough chemicals.

I would be very interested to know of your source for this info, And please don't quote some obscure article from a search engine. Which has most likely being added to google or others just for the sake of getting a posting on them.

[Serpico]

Yes, Doctors get free stuff if they sell enough product, free holidays, etc..

This should be illegal.

Same thing with suppliers selling crop chemicals to farmers. The chemical supply house will recommend high rates of applications and close intervals.

The chemical salesman will give away lots of free stuff if the farmer use enough chemicals.

I would be very interested to know of your source for this info, And please don't quote some obscure article from a search engine. Which has most likely being added to google or others just for the sake of getting a posting on them.

I dated a doctor and I was in agriculture.

If I wanted to spray my crops, I had to get a recommendation from a PCA Pest Control Advisor.

The PCA works for the chemical supply house. He sells enough stuff, gets a free trip.

That's how it works I'm afraid.

[sleepyjohn]

"Use Ciprofloxin 500 mg for 2/3 days..."

I believe the normal course for antibiotics is longer than 2-3 days.

I took the Cipro for the full ten days.

John

Edited July 4, 2009 by sleepyjohn

[EnricoCerrato]

Hi, I have an ear drum perforation from many years, and every now and then I experience pus collection in the outer ear canal, in Italy they gave me Mediflox, conteining Ciprofloxin and Hydrocortisone, and it always works fast. Any suggestion regarding what the name in Thailand or any similar products available here?

SJ,

Not enough clinical info about symptoms to offer specific advice.

The pain alone is not an indication of infection. Usually fever, headache and perhaps swelling of the regional glands in the upper neck area are associated.

Distinction also needs to be made wether this is a middle ear problem or an otitis externa (ear canal).

Otitis media in an adult is rare so it is more likely to be an otitis externa. This is usually a localised infection and better treated with local application of antibiotic ear drops etc.

What was the final diagnosis? Was there significant pain when the doc cleaned out the ear and how was that done?

Cleaning the ear canal is indicated when there is dead or infected tissue or pus collection in the outer ear canal. Definitely not indicated when a middle ear infection is suspected or when there is an ear drum perforation.

Cipro is very much abused all over India, SEA and has resulted in many bugs such as Typhoid becoming resistent to this. The advantage here is that Cipro does achieve fairly high concentrations in soft tissues but the indications must be very clear.

Best if a swab is taken from the infected area and cultured to determine the correct antibiotic to use.

A second opinion may be called for here.