From the Guidelines
Otitis externa treatment should prioritize topical medications, such as antibiotic ear drops, to reduce inflammation and infection, with a treatment duration of at least 7 days. The primary goal of treatment is to manage the infection and reduce symptoms, with the most effective treatment being eardrops alone, which may contain antibiotics, antiseptics, steroids, or a combination 1. When selecting eardrops, all approved options for treating acute otitis externa are highly effective, with no consistent advantage shown for any one specific drug 1. Key considerations for treatment include:
- Cleaning the ear canal with a bulb syringe and warm water or professional cleaning
- Using antibiotic ear drops like ciprofloxacin (Ciprodex) or neomycin-polymyxin B-hydrocortisone (Cortisporin) 3-4 drops, 3-4 times daily for 7-10 days
- Inserting a wick to deliver medication deeper into the ear canal if there's significant swelling
- Managing pain with acetaminophen or ibuprofen as needed
- Keeping the ear dry during treatment by avoiding swimming and using earplugs during showers It is essential to note that patients with diabetes, an immunocompromised state, or both require special consideration, as they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to acute otitis externa but require different management 1. If symptoms include fever, severe pain, or spread beyond the ear, immediate medical attention is necessary, as this may indicate a more serious infection requiring oral antibiotics 1.
From the FDA Drug Label
Ciprofloxacin and dexamethasone otic suspension is indicated for the treatment of infections caused by susceptible isolates of the designated microorganisms in the specific condition listed below: Acute Otitis Externa (AOE) in pediatric (age 6 months and older), adult and elderly patients due to Staphylococcus aureus and Pseudomonas aeruginosa. For the treatment of superficial infections of the external auditory canal caused by organisms susceptible to the action of the antimicrobial.
Treatment for Otitis Externa:
- Ciprofloxacin and dexamethasone otic suspension is indicated for the treatment of Acute Otitis Externa (AOE) due to Staphylococcus aureus and Pseudomonas aeruginosa 2, 2.
- Acetic acid otic solution is also used for the treatment of superficial infections of the external auditory canal caused by susceptible organisms 3. The recommended dosage for ciprofloxacin and dexamethasone otic suspension is four drops into the affected ear twice daily, for seven days 2.
From the Research
Otitis Externa Treatment Options
- The treatment of otitis externa typically involves the use of topical antimicrobials or antibiotics, such as acetic acid, aminoglycosides, polymyxin B, and quinolones 4.
- These agents may be used alone or in combination with topical corticosteroids to help resolve symptoms more quickly 4.
- Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact 4.
Comparison of Treatment Options
- A study comparing ciprofloxacin/dexamethasone with neomycin/polymyxin B/hydrocortisone found that ciprofloxacin/dexamethasone was clinically and microbiologically superior in the treatment of acute otitis externa 5.
- Another study found that ciprofloxacin/dexamethasone provided greater pain relief and a rapid reduction in severe pain compared to neomycin/polymyxin B/hydrocortisone 6.
- However, there is evidence to suggest that the pathogens most commonly associated with otitis externa are developing resistance to neomycin and polymyxin B, but not to ofloxacin 7.
Prevention and Prophylaxis
- Excessive moisture and trauma are common precipitants of otitis externa, and avoidance of these factors is essential for prevention 8.
- Thorough cleansing of the canal and acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation can be an effective treatment and prophylactic measure 8.
- Other prophylactic measures, such as drying the ears with a hair dryer and avoiding manipulation of the external auditory canal, may also help prevent recurrence 8.