From the Guidelines
Oral fluoroquinolones should not be the first-line treatment for ear infections in children with tympanostomy tubes, and instead, topical antibiotic ear drops such as ofloxacin or ciprofloxacin-dexamethasone should be used. According to the most recent and highest quality study 1, topical antibiotic therapy has been shown to have superior outcomes compared to systemic oral antibiotics for treating acute tympanostomy tube otorrhea (TTO) in children. The study found that topical therapy achieved higher clinical cure rates, bacterial eradication, and patient satisfaction compared to oral antibiotics.
The typical treatment for ear infections with visible drainage or discharge from the ear canal in children with tympanostomy tubes is antibiotic ear drops alone, such as ofloxacin or ciprofloxacin-dexamethasone, placed in the ear canal two times a day for up to 10 days 1. Oral antibiotics are unnecessary for most ear infections with tubes unless the child is very ill, has another reason to be on an antibiotic, or the infection does not go away after using ear drops.
Some key points to consider when treating ear infections in children with tympanostomy tubes include:
- Cleaning the ear canal of any debris or discharge before administering topical antibiotic drops to facilitate drug delivery
- Limiting topical therapy to a single course of no more than 10 days to avoid potential ototoxicity and promote antibiotic resistance
- Using only topical drops approved for use with tympanostomy tubes, such as quinolone drops with or without steroid
- Considering culture of persistent drainage from the ear canal to target future therapy and detect pathogens such as fungi and methicillin-resistant Staphylococcus aureus (MRSA)
Overall, the use of oral fluoroquinolones for ear infections in children with tympanostomy tubes should be reserved for cases where topical therapy has failed, the infection is severe, or the causative organism is resistant to other antibiotics, due to the potential side effects and risk of promoting antibiotic resistance 1.
From the Research
Oral Fluoroquinolone for Ear Infection
- The use of oral fluoroquinolone for ear infections has been studied in several research papers 2, 3, 4.
- A study published in 2017 found that oral ciprofloxacin was effective in treating external bacterial otitis, with a complete resolution of the inflammatory process in 93% of patients with acute external bacterial otitis and 90% of patients with exacerbation of chronic otitis externa 2.
- Another study published in 1991 found that fluoroquinolones, including ciprofloxacin, were effective in treating malignant otitis externa, with a cure rate of about 90% 3.
- A study published in 1994 compared the efficacy of oral ciprofloxacin with amoxycillin/clavulanic acid in treating chronic suppurative otitis media in adults, and found that ciprofloxacin was more effective in eradicating bacteria and resolving otorrhoea 4.
- The following bacteria were found to be commonly associated with ear infections:
- Staphylococcus aureus
- Pseudomonas aeruginosa
- The use of oral fluoroquinolone for ear infections has several advantages, including:
- Can be given orally
- Has a low rate of side effects
- Can be used to treat a wide range of bacterial pathogens
- However, it is worth noting that other antibiotics, such as amoxicillin and trimethoprim-sulfamethoxazole, have also been studied for the treatment of ear infections 5, 6.