From the Guidelines
For treating otitis externa, the recommended topical drops typically include antibiotic drops with or without steroids, such as ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex), ofloxacin 0.3% (Floxin Otic), or neomycin-polymyxin B-hydrocortisone (Cortisporin) 1. These medications are effective in combating bacterial infection while reducing inflammation in the ear canal, with the antibiotic component targeting common causative bacteria like Pseudomonas aeruginosa and Staphylococcus aureus, and the steroid component reducing swelling and pain. Some key points to consider when using these drops include:
- Administering 3-4 drops into the affected ear canal 2-4 times daily for 7-10 days
- Gently cleaning the ear canal of debris before application if possible
- Inserting an ear wick for severe cases with significant swelling to help deliver medication deeper into the canal
- Keeping the ear dry during treatment, avoiding swimming, and using earplugs when showering
- Monitoring for improvement within 48-72 hours and seeking medical reevaluation if symptoms do not improve or worsen, as alternative treatments or oral antibiotics may be required 1. It's also important to note that patients with certain conditions, such as diabetes or an immunocompromised state, may require special consideration and alternative management strategies to prevent complications like necrotizing otitis externa or otomycosis 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. The recommended dosage regimen for the treatment of Acute Otitis Externa (age 6 months and older) is as follows: Four drops instilled into the affected ear twice daily for seven days. Otitis Externa The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops instilled into the affected ear once daily for seven days. 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 topical drops for treating ear infections, specifically otitis externa, are:
- Ciprofloxacin and dexamethasone otic suspension: Four drops instilled into the affected ear twice daily for seven days 2.
- Ofloxacin otic solution: Five drops instilled into the affected ear once daily for seven days for pediatric patients, and ten drops instilled into the affected ear once daily for seven days for patients 13 years and older 3.
- Ciprofloxacin otic solution: Contents of one single-dose container should be instilled into the affected ear twice daily for 7 days 4.
From the Research
Topical Drops for Ear Infection
The following are recommended topical drops for treating ear infections, specifically otitis externa:
- Ofloxacin otic 0.3% solution, which has been shown to be effective in achieving clinical and microbiologic cure of otitis externa 5
- Ciprofloxacin 0.3%/dexamethasone 0.1% (CIP/DEX) otic suspension, which has been found to be clinically and microbiologically superior to neomycin/polymyxin B/hydrocortisone otic suspension in the treatment of mild to severe acute otitis externa 6
- Auricularum powder (dexamethasone 10 mg, oxytetracycline HCl 90,000 U, polymyxin B Sulfate 100,000 U, nystatin 1,000 U), which has been shown to be an effective and rapid method for the treatment of acute external otitis 7
Considerations for Treatment
When choosing a topical drop for otitis externa, consider the following factors:
- Tympanic membrane status: Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact 8
- Adverse effect profiles: Ofloxacin otic 0.3% solution has been found to be well tolerated with minor adverse events experienced by 3% of patients 5
- Adherence issues: A once-daily regimen of ofloxacin otic 0.3% solution may be better accepted by patients than longer, more repetitive regimens 5
- Cost: The choice of treatment should also consider cost, although there is no good evidence that any one antimicrobial or antibiotic preparation is clinically superior to another 8
Pathogens and Resistance
The most common pathogens associated with otitis externa are Pseudomonas aeruginosa and Staphylococcus aureus 9