What is the frequency and dose of Cipro (ciprofloxacin) and dex (dexamethasone) for acute otitis externa in an adult?

From the Guidelines

For acute otitis externa in adults, Cipro-dex (ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension) is typically administered as 4 drops into the affected ear(s) twice daily for 7 days. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of topical antibiotic therapy in treating acute otitis externa 1. Before application, it is essential to warm the bottle in your hands for 1-2 minutes to prevent dizziness from cold liquid entering the ear canal. The ear should be cleaned gently prior to administration, and after instilling the drops, the patient should lie with the affected ear upward for 1-2 minutes to ensure the medication penetrates properly.

Some key points to consider when using Cipro-dex for acute otitis externa include:

• The combination of an antibiotic (ciprofloxacin) and a steroid (dexamethasone) in Cipro-dex helps to kill bacteria causing the infection and reduce inflammation and associated symptoms like pain and swelling.
• Most patients experience symptom improvement within 48-72 hours, but the full course should be completed even if symptoms resolve earlier to prevent recurrence or antibiotic resistance.
• If symptoms worsen or don't improve after 3 days, medical reassessment is necessary to consider alternative treatments or further evaluation.
• Topical antibiotic therapy, such as Cipro-dex, has been shown to have superior outcomes compared to systemic oral antibiotics in treating acute otitis externa, with improved clinical cure rates and reduced adverse events 1.

It is crucial to follow the recommended dosage and administration guidelines to ensure effective treatment and minimize the risk of adverse events. Additionally, patients should be advised to limit topical therapy to a single course of no more than 10 days to avoid potential ototoxicity and other complications 1.

From the FDA Drug Label

2.2 Dosage For the Treatment of Acute Otitis Externa (age 6 months and older) The recommended dosage regimen is as follows: Four drops [equivalent to 0. 14 mL of ciprofloxacin and dexamethasone otic suspension, (consisting of 0.42 mg ciprofloxacin and 0. 14 mg dexamethasone)] instilled into the affected ear twice daily for seven days. The recommended dose of cipro-dex for acute otitis externa in an adult is:

• Four drops (equivalent to 0.14 mL) of ciprofloxacin and dexamethasone otic suspension, containing 0.42 mg ciprofloxacin and 0.14 mg dexamethasone
• Instilled into the affected ear twice daily for seven days 2

From the Research

Frequency and Dose of Cipro-Dex for Acute Otitis Externa in Adults

• The recommended dose of ciprofloxacin 0.3%/dexamethasone 0.1% (CIP/DEX) for acute otitis externa in adults is 3-4 drops twice daily 3, 4.
• The treatment duration is typically 7 days 3, 5, 4.
• Studies have shown that CIP/DEX is effective in treating acute otitis externa, with clinical cure rates ranging from 90.9% to 98% 3, 4.
• CIP/DEX has been compared to neomycin/polymyxin B/hydrocortisone (NPH) in several studies, with CIP/DEX showing superior clinical and microbiological outcomes 3, 5, 4, 6.

Comparison with Other Treatments

• CIP/DEX has been shown to be more effective than NPH in eradicating Pseudomonas aeruginosa, a common pathogen in acute otitis externa 6.
• The treatment failure rate for CIP/DEX was significantly lower than NPH for P. aeruginosa (5.1% vs 13.0%) 6.
• However, the treatment failure rates for Staphylococcus aureus were similar between CIP/DEX and NPH 6.

Safety and Tolerability

• CIP/DEX has been shown to be well tolerated in adults, with adverse event rates similar to those of NPH 3, 4.
• The most common adverse events associated with CIP/DEX include otic pruritus, otic congestion, and otic debris 4.