From the Guidelines
Treatment for otitis externa should prioritize topical medications and ear canal cleaning, with antibiotic ear drops such as ciprofloxacin or neomycin-polymyxin B-hydrocortisone being the first line of treatment, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1.
Key Considerations
- The ear canal should be cleaned gently with a solution of equal parts white vinegar and rubbing alcohol, or a commercial ear cleaning solution, to remove debris and promote healing.
- Topical antibiotic ear drops, such as ciprofloxacin (Ciprodex) or neomycin-polymyxin B-hydrocortisone (Cortisporin), should be applied 3-4 drops, 3-4 times daily for 7-10 days to effectively manage the infection.
- Pain relief can be achieved with acetaminophen or ibuprofen as needed, and it is essential to keep the ear dry during treatment by avoiding swimming and using earplugs during showers.
Special Considerations
- Patients with significant swelling may require a wick to be placed in the ear canal to help deliver medication, and those with severe infections or no improvement within a few days may need oral antibiotics like amoxicillin-clavulanate (500-875mg twice daily for 7-10 days) 1.
- It is crucial to identify patients with other disease processes that could seriously affect the outcome of otitis externa, such as diabetes, HIV infection, or immunocompromised states, and to modify management accordingly 1.
Administration of Topical Drops
- The affected ear should be positioned upward, and the drops should be run along the side of the canal until it is filled, with gentle to-and-fro movement of the pinna to eliminate trapped air and ensure filling 1.
- The patient should remain in this position for about 3 to 5 minutes to allow the drops to take effect, and the ear canal should be left open to dry and avoid trapping moisture and infected debris.
From the FDA Drug Label
The recommended dosage regimen for the treatment of otitis externa is: 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. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days.
The treatment for otitis externa is ofloxacin otic solution. The dosage regimen is as follows:
- For pediatric patients (6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) once daily for 7 days.
- For patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) once daily for 7 days 2.
From the Research
Treatment Options for Otitis Externa
- Topical antibiotics such as ofloxacin otic solution 0.3% have been shown to be effective in treating otitis externa, with clinical cure rates >80% in adults and >95% in children 3
- Ofloxacin otic solution 0.3% is as effective as topical neomycin/polymixin B/hydrocortisone preparations and oral amoxicillin/clavulanic acid in treating otitis externa and otitis media 3, 4
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is also an effective treatment for otitis externa 5
- Oral ofloxacin therapy has been shown to be effective in treating invasive external otitis, with a cure rate of 83.3% 6
- Topical antiseptics and steroids have been found to be as effective as topical antibiotics in treating acute otitis externa, with no significant differences in cure rates 7
Characteristics of Effective Treatments
- High concentrations of the active ingredient in the ear, such as with ofloxacin otic solution 0.3% 3
- Broad spectrum of activity against common ear pathogens 3
- Low risk of adverse events, such as with ofloxacin otic solution 0.3% 3, 4
- Convenience and ease of use, such as with oral ofloxacin therapy 6
- Lack of ototoxicity, such as with ofloxacin otic solution 0.3% 3, 4