What is the role of fluoroquinolone (antibiotic) in treating otitis (ear infection)?

From the Guidelines

Fluoroquinolones, such as ciprofloxacin, can be used to treat ear infections, particularly those involving the outer ear canal (otitis externa) or middle ear (otitis media) that haven't responded to first-line treatments, with a recommended regimen of 4 drops in the affected ear twice daily for 7 days 1. When considering the use of fluoroquinolones for ear infections, it's essential to weigh the potential benefits against the risks, including the development of antibiotic resistance and potential side effects.

• The most recent and highest quality study, published in 2022, suggests that topical antibiotic therapy, including fluoroquinolones, is effective in treating acute tympanostomy tube otorrhea (TTO) in children, with superior outcomes compared to systemic oral antibiotics 1.
• The study found that topical therapy achieved clinical cure rates ranging from 77% to 96%, compared to 30% to 67% with systemic antibiotic therapy 1.
• Fluoroquinolones, such as ciprofloxacin, are particularly effective against Pseudomonas aeruginosa, a common cause of swimmer's ear, and are often used as ear drops (e.g., Ciprodex) in combination with dexamethasone to reduce inflammation 1.
• However, fluoroquinolones are generally not first-line treatments due to potential side effects and concerns about antibiotic resistance, and are typically reserved for cases where other antibiotics have failed or when the infection is caused by resistant bacteria 1.
• Before applying ear drops, it's essential to clean the outer ear gently and lie with the affected ear facing upward for 1-2 minutes after administration to ensure the medication reaches the infection site 1.

From the FDA Drug Label

Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. Ciprofloxacin otic solution, 0.2% is for otic use only.

Fluoroquinolone use for ear infection: Ciprofloxacin otic solution, 0.2% is indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 2, 2, 2.

• The solution is for otic use only.
• It is a quinolone antimicrobial.
• The most common adverse reactions were application site pain, ear pruritus, fungal ear superinfection, and headache.

From the Research

Treatment Options for Ear Infections

• The use of fluoroquinolones for ear infections, specifically acute otitis externa, is mentioned in several studies as a treatment option 3, 4.
• Acute otitis externa is a common condition involving inflammation of the ear canal, and fluoroquinolones are one of the topical antimicrobials or antibiotics used to treat it 3.
• The choice of treatment for acute otitis externa is based on several factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost 3.
• Topical antibiotic treatments, including fluoroquinolones, are often used as first-line therapy for uncomplicated cases of acute otitis externa 3, 5.
• Oral antibiotics, such as fluoroquinolones, are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 3, 4.

Effectiveness of Fluoroquinolones

• A systematic review and meta-analysis found that antiseptic, steroid, and antibiotic monotherapies, including fluoroquinolones, are all effective for the management of acute otitis externa 6.
• There is insufficient evidence to suggest that topical antiseptic or steroid agents are superior or inferior to topical antibiotics, including fluoroquinolones, for the treatment of acute otitis externa 6.
• The rate of topical antibiotic prescriptions, including fluoroquinolones, for acute otitis externa was high in primary care, but the rate was frequently suboptimal in patients attending the ENT emergency clinic 4.