What antibiotic ear drops are recommended for a 13-year-old girl with a ruptured tympanic membrane (TM)?

From the Guidelines

Antibiotic ear drops, specifically ofloxacin or ciprofloxacin-dexamethasone, are recommended for a 13-year-old girl with a ruptured tympanic membrane (TM) and signs of infection, as they provide targeted treatment with minimal risk of systemic side effects 1. Recommended treatment:

• Ofloxacin or ciprofloxacin-dexamethasone ear drops, 2-3 times a day for up to 10 days Additional important points:

1. Clean the ear canal of any debris or discharge before administering the drops to ensure effective delivery of the antibiotic.
2. Use pain relievers like acetaminophen or ibuprofen as needed for discomfort.
3. Follow up with a healthcare provider in 2-3 weeks to ensure proper healing and to assess the need for further treatment. Justification: The use of antibiotic ear drops in this scenario is supported by the most recent clinical practice guideline, which recommends topical antibiotic therapy as the first-line treatment for acute TTO in children with tympanostomy tubes 1. This approach avoids the adverse events associated with systemic antibiotics and provides improved coverage of likely pathogens, especially P aeruginosa. However, it's essential to note that the presence of a ruptured TM may affect the choice of treatment, and oral antibiotics may be considered in certain cases, such as severe infection or failure of topical therapy 1.

From the FDA Drug Label

Ofloxacin otic solution is an antibiotic in a sterile solution used to treat ear infections caused by certain bacteria found in: patients (12 years and older) who have a middle ear infection and have a hole in the eardrum For a Middle Ear Infection: The person receiving ofloxacin otic solution should lie on his/her side with the infected ear up. Patients (12 and older) should have 10 drops of ofloxacin otic solution put into the infected ear

The recommended antibiotic ear drop for a 13-year-old girl with a ruptured tympanic membrane (TM) is ofloxacin otic solution. The dosage is 10 drops in the infected ear, twice a day, for as long as the doctor has instructed 2.

From the Research

Recommended Antibiotic Ear Drops

• Ofloxacin otic solution 0.3% is recommended for the treatment of ear infections, including otitis externa and otitis media, in patients with tympanic membrane perforations or tympanostomy tubes 3, 4.
• The high concentrations of ofloxacin achieved with this ototopical solution render it active against a broad spectrum of organisms, and it is well tolerated, avoiding many systemic adverse events 3.
• Ofloxacin otic solution 0.3% is also effective in the treatment of chronic suppurative otitis media in adolescents and adults with perforated tympanic membranes, with a clinical cure rate of 75 to 91% 3.

Efficacy in Traumatic Tympanic Membrane Perforations

• Ofloxacin ear drops have been shown to be effective in reducing healing time and increasing the rate of tympanic membrane perforation closure in patients with traumatic tympanic membrane perforations 5, 6.
• A systematic review and meta-analysis found that ofloxacin ear drops had a significant effect on closure of tympanic membrane perforations, with a relative risk of 1.18 and a mean difference in healing time of -18.4 days 6.

Safety and Tolerability

• Ofloxacin otic solution 0.3% is well tolerated, with adverse events usually classed as mild to moderate, and the most frequent adverse events being bitter taste and pruritus 3.
• No ototoxicity was detected in clinical studies in humans, and ofloxacin was not ototoxic or chondrotoxic in animal studies 3.
• The incidence of adverse events with ofloxacin otic solution 0.3% was similar to that with other ototopical preparations and significantly less than that with oral amoxicillin/clavulanic acid 3.