From the Guidelines
The recommended dose of neomycin-containing antibiotic drops for treating otitis externa is typically 3-4 drops instilled into the affected ear(s) three to four times daily for 7-10 days. Before application, the external ear canal should be gently cleaned of debris and discharge. The patient should lie with the affected ear upward for 3-5 minutes after instillation to ensure proper distribution of the medication. Neomycin is often combined with polymyxin B and hydrocortisone in commercial preparations to provide both antimicrobial coverage and anti-inflammatory effects. This combination helps address both the infectious and inflammatory components of otitis externa. It's essential to note that neomycin-containing eardrops can cause contact sensitivity, which has a 13% to 30% prevalence on patch testing of patients with chronic otitis externa 1.
Important Considerations
- Patients should avoid getting water in the ear during treatment and should not use cotton swabs which can push debris deeper into the canal.
- If symptoms worsen or do not improve after 48-72 hours of treatment, medical reevaluation is necessary as this may indicate fungal infection or other complications requiring different management.
- The treatment should be completed for the full course even if symptoms improve earlier to prevent recurrence.
- It is crucial to identify patients with other disease processes that could seriously affect the outcome of AOE, such as diabetes, HIV infection, or other immunocompromised states 1.
- Necrotizing (malignant) otitis externa is an aggressive infection that predominantly affects elderly, diabetic, or immunocompromised patients, and its diagnosis and management differ from those of typical AOE 1.
Management and Prevention
- Aural toilet (suction, dry mopping, irrigation, removal of obstructing cerumen or foreign object) is an essential part of the treatment.
- Non-antibiotic (antiseptic or acidifying) drops, steroid drops, and oral antibiotics may be considered based on the patient's condition and response to treatment 1.
- Water precautions, prophylactic drops, environmental control, and addressing underlying dermatitis are important preventive measures 1.
- Patients with a history of allergy to neomycin or other components of the drops should avoid their use 1.
From the Research
Recommended Dose of Neomycin Drops for Otitis Externa
- The recommended dose of neomycin drops for otitis externa is not explicitly stated in the provided studies, but the dosage of neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension can be found in study 2, which is three drops four times daily for 7-10 days.
- In study 3, the dosage of Cortisporin otic solutions (neomycin sulfate, polymyxin B sulfate, and hydrocortisone) is 0.2 mL four times daily for 10 days for adults, and 0.15 mL four times daily for 10 days for children.
- It is essential to note that the dosage may vary depending on the specific formulation and the patient's age and condition, and it is always best to consult a healthcare professional for the correct dosage and treatment regimen.
Comparison with Other Treatments
- Study 2 compares the efficacy of once-daily ofloxacin otic solution with neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension four times daily, and finds that both treatments have equivalent cure rates.
- Study 4 finds that ofloxacin otic is as effective as the preparation combining polymyxin/neomycin plus hydrocortisone in curing otitis externa in children.
- Study 3 compares the safety and efficacy of ofloxacin otic solution with Cortisporin otic solutions and finds that both treatments have similar cure rates and adverse event rates.
Safety and Efficacy
- Study 2 finds that once-daily ofloxacin otic solution is as effective and safe as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension four times daily in the treatment of otitis externa in children.
- Study 4 notes that ofloxacin otic has the advantage of less frequent dosing and lack of ototoxicity, making it a safe option for use in patients with undiagnosed tympanic membrane perforation.
- Study 3 finds that ofloxacin given twice daily is as safe and effective as Cortisporin given four times daily for otitis externa.