ENT infection antibiotics
also: sore throat penicillin · otitis media amoxicillin · sinusitis · malignant otitis externa
Overview
Antibiotics for ENT infections, in context — the sore-throat penicillin (and the avoid-amoxicillin/check-FBC pitfalls), otitis media, bacterial sinusitis and the malignant-OE emergency.
Mechanism
Pathogen-directed. Most ENT bacterial infection is Strep/H. influenzae/M. catarrhalis → penicillins; malignant OE is Pseudomonas → an anti-pseudomonal fluoroquinolone. (Full class mechanisms: Antimicrobials section.)
Indications
- Bacterial tonsillitis/pharyngitis (Centor/FeverPAIN)
- Acute otitis media (when indicated)
- Bacterial / chronic rhinosinusitis
- Malignant (necrotising) otitis externa
- Peritonsillar abscess (quinsy)
The agents
7–10 days
First-line if Centor ≥3 / FeverPAIN ≥4; clarithromycin if penicillin-allergic.
5–7 days
AOM if <2y bilateral, otorrhoea, or systemically unwell / not settling.
systemic
Anti-pseudomonal — skull-base osteomyelitis in diabetics/immunocompromised; urgent ENT + IV abx.
Option in chronic rhinosinusitis with polyps.
Adverse effects
Avoid amoxicillin in sore throat — use penV (rash if the cause is EBV).
If a sore-throat patient is on a DMARD or carbimazole → urgent FBC (could be neutropenic sepsis, not simple tonsillitis).
Cautions & contraindications
EBV rash; penV preferred.
Ototoxicity (see Ear drops card).
Interactions
- Clarithromycin: CYP3A4 (statins, warfarin)
Monitoring & kinetics
Most AOM/sore throat are self-limiting — antibiotics only per criteria,Urgent FBC if sore throat on carbimazole/DMARD
Oral; IV anti-pseudomonal for malignant OE. See Antimicrobials for full pharmacology.
Source: NICE NG84 — Sore throat · NICE CKS — Otitis media / sinusitis