From the Guidelines
For otitis externa, the recommended treatment is typically topical antibiotic ear drops with or without steroids, such as Ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex), administered as 4 drops into the affected ear twice daily for 7 days 1. The choice of medication depends on the severity of the infection and the presence of any underlying conditions, such as diabetes or immunocompromised states.
- Topical antibiotic ear drops, such as ofloxacin 0.3% (5 drops twice daily) or neomycin-polymyxin B-hydrocortisone (4 drops three times daily), can be used as alternative options 1.
- Before applying drops, the ear canal should be gently cleaned of debris if possible to ensure effective delivery of the medication.
- Pain management with acetaminophen or NSAIDs is often necessary to alleviate discomfort and reduce inflammation.
- For severe cases with significant canal swelling, an ear wick may be inserted to facilitate medication delivery 2.
- It is essential to note that patients with diabetes, immunocompromised states, or a history of radiotherapy may require special consideration and potentially systemic antibiotics in addition to topical therapy 2.
- The treatment should be tailored to the individual patient's needs, and the patient should avoid getting water in the ear during treatment and for about a week afterward to allow complete healing.
From the FDA Drug Label
Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. 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.
Medications for otitis external include:
- Ciprofloxacin (OTIC): indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 3
- Ofloxacin (OTIC): used for the treatment of otitis externa in patients from 6 months to 13 years old and patients 13 years and older 4
From the Research
Medication for Otitis Externa
- Otitis externa is a common ear infection that can be caused by bacterial or fungal infections, and treatment typically involves topical antibiotics or antifungals 5.
- Ofloxacin otic solution 0.3% is a topical antibiotic that has been shown to be effective in treating otitis externa, with clinical cure rates of over 80% in adults and over 95% in children 6.
- Ciprofloxacin is another antibiotic that has been used to treat otitis externa, and has been shown to be effective in eradicating bacterial pathogens and reducing symptoms 7, 8.
- A comparison of ciprofloxacin/dexamethasone with neomycin/polymyxin/hydrocortisone for otitis externa pain found that ciprofloxacin/dexamethasone provided greater pain relief and reduced inflammation and edema more effectively 9.
Topical Treatments
- Topical administration of ofloxacin otic solution 0.3% produces high concentrations of the drug in the ear, making it effective against a broad spectrum of organisms 6.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is also an effective treatment for otitis externa 5.
- Ciprofloxacin 0.3%/dexamethasone 0.1% is a topical treatment that has been shown to provide rapid relief of severe pain and reduce inflammation and edema 9.
Oral Treatments
- Oral ciprofloxacin has been used to treat otitis externa, and has been shown to be effective in eradicating bacterial pathogens and reducing symptoms 7.
- A study found that oral ciprofloxacin 500mg twice daily for 7 to 10 days was clinically and microbiologically effective in treating otitis externa, with complete resolution of the inflammatory process in 93% of patients with acute external bacterial otitis and 90% of patients with exacerbation of chronic otitis externa 7.