Doctor Frank? Any doctor? Pseudomonas, Strep A & mixed Anaerobes in ear, unsure if given right treatment?

Question

My daughter has grommets (right one is working it's way out) and had a swab for a discharging, smelly left ear. Diagnosed with Otitis Externa.

Results were: Pseudomonas - sensitive to gentamicin and 4 other antibiotics I am not familiar with - couldn't read GP's handwriting to quote the others!

Grp A Strep - sensitive to Penicillin, Erythromycin, Amoxicillin, tetracycline, Clindamycin

Mixed Anaerobes - sensitive to Metronidazole.

GP got her rapid access app't for today, for aural toilet. Was advised by ENT to prescribe Gentisone HC for now (Just saw GP yesterday).

By the time we had rapid access app't her ear looked better, discharging far less. Though of course the drops contain HC, as a non medical person I would assume some effect could be from that, and possibly also the gentomicin working on the Pseudomonas, which she has had several times before.

We saw the registrar, who didn't even mention Aural Toilet, though that was what the apppointment was for (I just expected him to say it wasn't needed if that was the case!) he simply wrote out a RX for Gentisone HC even though I told him she got that yesterday...

I am worried that the Gentisone may not clear up the Strep A and the mixed anaerobes.

I told him so (I am no shrinking violet in a surgery I am afraid - have had to fight for the correct treatment too many times, sadly mistakes HAVE been made with my daughter on several occasions)

He said to come back in three weeks and see.

My GP was more concerned with the Strep A than the others.

Could Gentomicin drops alone actually cure her infection?

I will add that I am well aware of the risks of overuse of antibiotics, but at the same time if they are needed, they are needed!

Please advise me! Thank you.

Answer 1

it is a long question, and I am not sure you mention if she has had other ear drops recently. There is certainly a mixed bag of organisms there! ENT surgeons like gentamycin and gentamycin HC, despite the fact that gentamycin is oto-toxic ( theoretically it can damage the nerve, especially if the drum is perforated, which of course it always is if grommets are present.) and despite the concerns about using steroids when infection is present. Fortunately in practice, provided the gentamycin ( or GM HC) is not used for too long, neither of these theoretical risks ever seem to cause a problem in clinical ENT practice. I might have wondered, particularly if the ear in so inflamed, if in addition, an oral antibiotic might have been useful. Aural toilet is only useful if there is a lot of local debris in the canal. Another possibly useful option, which is sometimes used, is antibiotic wicks, but these have to be changed daily by ENT, rather than your GP.



I am afraid it is unwise of me to be anything other than pretty general with my comments and suggestions.

Answer 2

a good physician has following factors.. *His social or communique skills with the sufferers which constitutes the two verbal and non-verbal (physique language) communique...As our profession is a community provider. *He could be a function sort (a doctor who tells his/her sufferers to offer up smoking should not be seen smoking exterior the hospital 5 minutes after the affected person leaves.. the place's the intergrity for the time of this suitable?) *He could have the means to communicate in a fashion the affected person knows (not likely off on the homes of amino acids... and so on. and so on) as this could come out as conceitedness *He, ideally could persist with up on his sufferers ... supply them telephone calls to verify how they're doing *The physician could be keen to coach!!... this is going alongside o.k. with preventive well being care. The physician could supply the sufferers the fishing rods, particularly than the fish. If a doctor is attentive to the thank you to coach his/her affected person what to do and what to not do, the physician could have the means to help the affected person exchange his way of life for the greater advantageous so as that the affected person would not could shop coming back. *>And final yet not the least he could be sensible, as much as date, And maximum Of all ethical. Dr Suraj A ok

Answer 3

Here here to not being a shrinking violet!! I'm a real pain in the as$ at my surgery believe me. Gentomicin drops alone could well cure her infection, you've been given the three week check up appointment, so wait and see what happens, if things get worse or she is in any more pain, see your GP sooner. I think at this juncture, wait and see of the Gentomicin has any effect, I'm sure your GP will advise further treatment if it doesn't.



(Dr Frank is in high demand this PM, I think that's the third question I've seen for him today, one insult and two other questions and neither of them from lbobeck! )