From the Guidelines
For otitis externa when the tympanic membrane cannot be visualized on otoscopic examination, topical antibiotic ear drops without aminoglycosides should be prescribed. A good first-line option is ciprofloxacin 0.3% with dexamethasone 0.1% otic suspension, 4 drops instilled into the affected ear(s) twice daily for 7 days 1. Alternatively, acetic acid 2% solution or ofloxacin 0.3% otic solution can be used with similar dosing. It's crucial to avoid aminoglycoside-containing drops (like neomycin or gentamicin) when the tympanic membrane status is unknown because if a perforation exists, these medications can cause ototoxicity and permanent hearing loss 1. The combination of antibiotic and steroid helps address both infection and inflammation.
Some key points to consider when treating otitis externa include:
- The importance of gentle ear canal cleaning before instilling drops, if possible
- Advising patients to keep the ear dry during treatment
- Scheduling a follow-up if symptoms don't improve within 48-72 hours for further evaluation once inflammation subsides 1
- Being aware of potential side effects of eardrops, such as local rash, itching, irritation, or discomfort, although these are rarely severe enough to require stopping the medication 1
The goal of treatment is to effectively manage the infection, reduce pain, and prevent potential complications, all while considering the patient's overall quality of life and minimizing risks associated with the treatment itself.
From the FDA Drug Label
The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days.
If the tympanic membrane cannot be accounted for on otoscopic examination, ofloxacin (OTIC) ear drops should be prescribed for otitis externa. The dosage is:
- For pediatric patients (from 6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) once daily for 7 days.
- For patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) once daily for 7 days 2.
From the Research
Ear Drops for Otitis Externa
When the tympanic membrane cannot be accounted for on otoscopic examination, the choice of ear drops for otitis externa is crucial. The following points summarize the key findings:
- Ofloxacin otic solution is effective in treating otitis externa, with a clinical cure rate of over 80% in adults and over 95% in children 3.
- Ofloxacin otic solution is as effective as topical neomycin/polymixin B/hydrocortisone preparations in treating otitis externa 3.
- Ciprofloxacin/dexamethasone may delay tympanic membrane healing, whereas ofloxacin does not 4, 5.
- Ofloxacin is a safe option for patients with undiagnosed tympanic membrane perforation due to its lack of ototoxicity 6, 3.
Recommended Ear Drops
Based on the evidence, ofloxacin otic solution is a suitable choice for treating otitis externa when the tympanic membrane cannot be accounted for on otoscopic examination, due to its efficacy and safety profile 6, 3.
Key Considerations
- The lack of ototoxicity associated with ofloxacin makes it a safe option for use in patients with potential tympanic membrane perforation 6, 3.
- Ciprofloxacin and other quinolones may have a greater impact on delaying tympanic membrane healing compared to ofloxacin 5.
- Topical administration of antibiotics, such as ofloxacin, may be more effective than systemic administration in achieving resolution of ear discharge 7.