From the Guidelines
Ciprofloxacin-hydrocortisone is the recommended treatment for ear infections with tympanostomy tubes, with a typical dosage of 2 drops in the affected ear twice daily for up to 10 days, as it has been shown to be effective in treating acute tympanostomy tube otorrhea (TTO) in children 1.
Treatment Overview
The treatment of ear infections with tympanostomy tubes involves the use of topical antibiotic ear drops, with ciprofloxacin-hydrocortisone being a commonly used combination medication. This medication contains ciprofloxacin, an antibiotic that kills bacteria, and hydrocortisone, a steroid that reduces inflammation and swelling.
Dosage and Administration
The typical dosage of ciprofloxacin-hydrocortisone for ear infections with tympanostomy tubes is 2 drops in the affected ear twice daily for up to 10 days, as recommended by the clinical practice guideline for tympanostomy tubes in children 1. Before application, the ear canal should be cleaned gently to remove any debris or discharge, and the drops should be instilled with the affected ear up, pulling the outer ear gently to straighten the ear canal.
Efficacy and Safety
Ciprofloxacin-hydrocortisone has been shown to be effective in treating acute TTO in children, with superior outcomes compared to systemic oral antibiotics in terms of clinical cure, bacterial eradication, and patient satisfaction 1. The use of topical antibiotic therapy also avoids adverse events associated with systemic antibiotics, such as dermatitis, allergic reactions, and gastrointestinal upset.
Important Considerations
It is essential to note that only topical drops approved for use with tympanostomy tubes should be prescribed, and caregivers should be advised to limit topical therapy to a single course of no more than 10 days to avoid potential ototoxicity and secondary fungal infections 1. Additionally, children who fail topical therapy may require further cleaning of the ear canal or suctioning of the tube lumen to facilitate drug delivery, and culture of persistent drainage from the ear canal may help target future therapy.
From the FDA Drug Label
In a randomized, multi-center, evaluator-blinded study of patients with acute otitis externa, patients were treated with either ciprofloxacin otic solution, 0.2% twice daily or neomycin and polymyxin B sulfates and hydrocortisone otic solution (PNH) three times daily for 7 days. The ciprofloxacin was compared to a solution containing hydrocortisone in a clinical study.
- The study found that ciprofloxacin had a higher clinical cure rate (70%) compared to the solution containing hydrocortisone (60%) 2.
From the Research
Ciprofloxacin and Hydrocortisone
- Ciprofloxacin and hydrocortisone is a combination used to treat otitis externa, with studies showing its efficacy and safety 3, 4.
- A study comparing ciprofloxacin/dexamethasone with neomycin/polymyxin B/hydrocortisone found that the ciprofloxacin combination had higher clinical cure rates and microbiologic eradication rates 3.
- Another study found that ciprofloxacin and hydrocortisone was clinically equivalent to neomycin/polymyxin B/hydrocortisone plus amoxicillin in treating acute otitis externa 4.
Mechanism of Action
- Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent that attains therapeutic concentrations in most tissues and body fluids 5.
- Hydrocortisone is a corticosteroid that reduces inflammation and swelling in the ear canal.
Efficacy and Safety
- Studies have shown that ciprofloxacin and hydrocortisone is effective in treating otitis externa, with high clinical cure rates and low adverse event rates 3, 4, 6.
- Ciprofloxacin has been found to be effective against a wide range of Gram-negative bacteria, including Pseudomonas aeruginosa, which is commonly found in otitis externa 7, 5.
- The combination of ciprofloxacin and hydrocortisone has been found to be well-tolerated, with no major side effects reported in most studies 3, 4, 6.