What is the treatment for a 5-year-old (YOF: years old female) with otitis externa and recently placed tympanostomy tubes 2 weeks ago?

From the Guidelines

For a 5-year-old with otitis externa and recently placed tympanostomy tubes, I strongly recommend using antibiotic ear drops, specifically ofloxacin or ciprofloxacin-dexamethasone, as the first line of treatment, as they are safe for use with tubes and effective against common pathogens 1. The treatment approach should prioritize the use of topical antibiotic therapy, which has been shown to have superior outcomes compared to systemic oral antibiotics in terms of clinical cure, bacterial eradication, and patient satisfaction 1. Key considerations in the management of otitis externa with tympanostomy tubes include:

• Using antibiotic ear drops that are safe for use with tubes, such as ofloxacin or ciprofloxacin-dexamethasone, to avoid potential ototoxicity 1
• Applying the drops correctly, by gently pulling the pinna upward and backward to straighten the ear canal, and having the child lie with the affected ear upward for 2-3 minutes after application
• Keeping the ear canal dry during treatment by using ear plugs or a cotton ball coated with petroleum jelly during bathing
• Monitoring for signs of improvement or worsening, such as pain, fever, or drainage, and seeking prompt reevaluation if symptoms do not improve within 48-72 hours 1 It is also important to note that 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 1. Overall, the goal of treatment is to effectively manage the infection, prevent complications, and minimize the risk of hearing damage or other adverse outcomes, while also considering the potential risks and benefits of different treatment approaches 1.

From the FDA Drug Label

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. The patient is 5 years old, which falls within the pediatric patients range. The recommended treatment for otitis externa is ofloxacin (OTIC), with a dosage of five drops instilled into the affected ear once daily for seven days 2.

• The presence of tympanostomy tubes does not change the recommended dosage for otitis externa.
• However, it's essential to note that the patient has recently had tympanostomy tubes placed, and the treatment should be administered with caution.
• The dosage regimen for acute otitis media with tympanostomy tubes is different, but it's not directly applicable to this case of otitis externa.

From the Research

Treatment of Otitis Externa with Recently Placed Tympanostomy Tubes

• The treatment of otitis externa in a 5-year-old patient with recently placed tympanostomy tubes 2 weeks ago can be managed with topical antibiotic solutions 3, 4, 5.
• Ofloxacin otic solution 0.3% has been shown to be effective in the treatment of otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes, with a clinical cure rate of >80% in adults and >95% in children 3.
• Topical ofloxacin has been compared to oral amoxicillin/clavulanic acid in the treatment of otitis media in children with tympanostomy tubes, with similar clinical cure rates (76% vs 69%) 3, 5.
• However, other studies have shown that topical ciprofloxacin/dexamethasone otic suspension may be superior to ofloxacin otic solution in the treatment of acute otitis media with otorrhea through tympanostomy tubes, with a clinical cure rate of 90% vs 78% 6.
• A recent study found no significant difference in the rate of postoperative otorrhea when choosing between oxymetazoline, ofloxacin, or ciprofloxacin/dexamethasone drops for use in the postoperative period after tympanostomy tube placement 7.

Considerations for Treatment

• The choice of treatment should be based on the severity of the infection, the presence of any underlying conditions, and the patient's medical history 3, 4, 5.
• Topical antibiotic solutions such as ofloxacin or ciprofloxacin/dexamethasone may be preferred over oral antibiotics due to their targeted delivery and reduced risk of systemic side effects 3, 4, 5, 6.
• The patient's age and weight should also be considered when selecting a treatment, as some topical solutions may be more suitable for pediatric patients 3, 4, 5, 6.