From the Guidelines
For otitis externa, all eardrops approved for treating the condition, including those containing flumethasone, cliquinol, and Otocomb, are highly effective with no consistent advantage shown for any one specific drug 1.
Key Considerations
When choosing an eardrop for otitis externa, factors such as cost, dosing frequency, status of the eardrum, and the doctor’s experience should be considered 1.
- The patient's opinion and preferences should also be taken into account.
- It is essential to inform the doctor about any prior ear surgery, eardrum perforation, or ear tube placement, as well as any history of reactions to ear drops or antibiotics.
Treatment Regimen
The recommended treatment duration for otitis externa is at least 7 days, even if symptoms improve sooner, to prevent relapse of infection 1.
- Patients should avoid getting water in the ears during treatment and complete the full course to prevent recurrence.
- Pain medicine can be used for relief in the first few days, until the eardrops begin working, but pain-relieving (anesthetic) eardrops are not recommended during an active ear canal infection 1.
Monitoring and Follow-up
Patients should notify their doctor if pain or other symptoms fail to respond within 48 to 72 hours, or if symptoms persist beyond 7 days 1.
- The doctor may need to adjust the treatment plan or prescribe additional medications if necessary.
Safety and Side Effects
Eardrops are generally safe and well-tolerated, but patients should be aware of potential side effects such as local rash, itching, irritation, or discomfort 1.
- If the patient experiences any unexpected symptoms or the drops become painful, they should inform their doctor promptly.
From the Research
Comparison of Topical Treatments for Otitis Externa
- The provided studies do not directly compare topical flumethasone, cliquinol, and Otocomb ear drops for the treatment of otitis externa.
- However, the studies suggest that topical antibiotic treatments, such as ofloxacin otic solution, are effective in treating otitis externa 2, 3.
- A systematic review and meta-analysis found that antiseptic, steroid, and antibiotic monotherapies are all effective for the management of acute otitis externa, with no significant differences in cure rates between them 4.
- A clinical comparison of hydrocortisone butyrate with oxytetracycline/hydrocortisone acetate-polymyxin B found that the overall cure rate was 80%, with no significant difference in therapeutic efficacy between the preparations except for Staph. aureus infections, which were more effectively treated with hydrocortisone butyrate 5.
- Another study compared local ciprofloxacin with local oxytetracycline, polymyxin B, hydrocortisone combination treatment and found that ciprofloxacin was a useful and effective agent in the local therapy of otitis externa 6.
- The declining susceptibility to neomycin and polymyxin B of pathogens recovered in otitis externa clinical trials suggests that alternative treatments, such as ofloxacin, may be more effective 3.
Efficacy of Different Treatments
- Ofloxacin otic solution has been shown to be as effective as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension in treating otitis externa 2.
- Ciprofloxacin has been found to be a useful and effective agent in the local therapy of otitis externa 6.
- Hydrocortisone butyrate has been shown to be effective in treating Staph. aureus infections in otitis externa 5.
- Antiseptic and steroid monotherapies have been found to be effective in managing acute otitis externa, with no significant differences in cure rates compared to antibiotic monotherapies 4.