From the Guidelines
For otitis externa with mastoid tenderness, the recommended antibiotic course is: Oral ciprofloxacin 500 mg twice daily for 7-10 days, combined with topical ciprofloxacin 0.2% ear drops, 4 drops in the affected ear(s) twice daily for 7-10 days. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of identifying patients with acute otitis externa (AOE) who may have other disease processes that could seriously affect the outcome of AOE 1. The study highlights that patients with AOE are susceptible to various complications, including necrotizing otitis externa and otomycosis, which may present similar to AOE but require different management.
Key considerations for the recommended antibiotic course include:
- Ciprofloxacin provides broad-spectrum coverage against common pathogens in otitis externa, including Pseudomonas aeruginosa, which is isolated from exudate in the ear canal in more than 90% of cases of necrotizing otitis externa 1
- The combination of oral and topical antibiotics ensures both systemic and local treatment, which is essential for managing AOE, especially in patients with mastoid tenderness, which suggests possible spread beyond the external ear canal 1
- Topical antimicrobials are beneficial for AOE, but oral antibiotics have limited utility, and the oral antibiotics selected should be active against P aeruginosa and S aureus, which are the most common pathogens in AOE 1
Additional recommendations include:
- Cleaning the ear canal gently before applying drops
- Using oral analgesics like acetaminophen or ibuprofen for pain relief
- Avoiding water exposure to the affected ear(s) It is essential to monitor for improvement within 48-72 hours, and if symptoms worsen or do not improve, consider referral to an ENT specialist to rule out more serious conditions like malignant otitis externa 1.
From the Research
Antibiotic Course for Otitis Externa and Mastoid Tenderness
The following information is based on studies related to the treatment of otitis externa and mastoid tenderness:
- The appropriate antibiotic course for a patient with otitis externa and mastoid tenderness may involve the use of ciprofloxacin, as it has been shown to be effective in treating external bacterial otitis 2, 3, 4, 5.
- A study published in 2017 found that ciprofloxacin 500 mg, administered orally twice daily for 7 to 10 days, was clinically and microbiologically effective in treating otitis externa patients 2.
- Another study published in 1994 found that ciprofloxacin, administered orally at a dosage of 750 mg twice daily, was effective in treating malignant external otitis, with a clinical cure rate of 96.4% 3.
- The combination of ciprofloxacin and rifampin has also been shown to be effective in treating malignant external otitis, with a clinical and bacteriologic cure rate of 91% 4.
- The distribution of oral ciprofloxacin into the mucosa of the middle ear and the cortical bone of the mastoid process has been studied, and the results suggest that ciprofloxacin may be an effective agent for the treatment of chronic suppurative otitis 5.
- Ofloxacin otic solution, administered once daily for 7 days, has also been shown to be effective in treating otitis externa, with a cure rate of 91% among clinically evaluable patients 6.
Key Findings
- Ciprofloxacin is effective in treating external bacterial otitis and malignant external otitis.
- The combination of ciprofloxacin and rifampin may be effective in treating malignant external otitis.
- Ofloxacin otic solution is effective in treating otitis externa.
- The distribution of oral ciprofloxacin into the mucosa of the middle ear and the cortical bone of the mastoid process suggests that it may be an effective agent for the treatment of chronic suppurative otitis.