From the Guidelines
For chronic infections after mastoidectomy, antibiotic ear drops containing fluoroquinolones like ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex) or ofloxacin 0.3% (Floxin Otic) are typically recommended as first-line treatments. These should be administered as 3-4 drops twice daily for 7-14 days, depending on infection severity. The choice of ear drops is crucial, and as stated in the clinical practice guideline for acute otitis externa 1, all eardrops approved for treating AOE are highly effective, with no consistent advantage shown for any one specific drug. However, factors such as cost, dosing frequency, status of the eardrum, and the doctor’s experience should be considered when selecting an eardrop, as mentioned in the guideline 1.
Before application, the ear canal should be gently cleaned of debris to allow medication to reach infected areas. Patients should lie with the affected ear upward for 3-5 minutes after instillation to ensure proper distribution. Fluoroquinolones are preferred because they provide broad-spectrum coverage against common pathogens like Pseudomonas aeruginosa and Staphylococcus aureus while causing minimal ototoxicity, making them safer for use in patients with compromised middle ear structures following mastoidectomy. It is essential to note that eardrops are generally safe and well-tolerated, but patients should be aware of potential side effects such as local rash, itching, irritation, or discomfort, as reported in the guideline 1.
Key considerations for managing chronic infections after mastoidectomy include:
- Identifying potential complications from delayed management and reducing pain
- Selecting an appropriate eardrop based on factors such as cost, dosing frequency, and status of the eardrum
- Ensuring proper administration and distribution of the eardrop
- Monitoring for potential side effects and adjusting treatment as needed.
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 FDA drug label does not answer the question about ear drops for chronic infection post mastoidectomy, as the label only discusses the treatment of Acute Otitis Externa.
From the Research
Ear Drops for Chronic Infection Post Mastoidectomy
- The use of topical antibiotics for chronic suppurative otitis media (CSOM) has been studied, and some evidence suggests that they may be effective in resolving ear discharge 2.
- A study comparing topical ciprofloxacin to placebo or no treatment found that ciprofloxacin was better in terms of resolution of discharge at one to two weeks, although the certainty of the evidence is low 2.
- Another study found that topical 0.2% ciprofloxacin solution in single-dose containers was effective and well tolerated in patients with CSOM 3.
- The efficacy and safety of topical ciprofloxacin/dexamethasone versus neomycin/polymyxin B/hydrocortisone for otitis externa has also been compared, with ciprofloxacin/dexamethasone found to be clinically and microbiologically superior 4.
- Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy for patients with persistent tympanostomy tube otorrhea who have failed topical and oral antibiotics 5.
Recommended Ear Drops
- Ciprofloxacin 0.2% solution or 0.3%/dexamethasone 0.1% otic suspension may be recommended for patients with chronic infection post mastoidectomy, based on the available evidence 2, 3, 4.
- However, the certainty of the evidence is generally low, and more research is needed to determine the most effective treatment for this condition 2.
Considerations
- The choice of ear drops may depend on the specific causative agents of the infection, as well as the patient's medical history and other factors 2, 5.
- Patients should be closely monitored for adverse effects and treatment outcomes, and alternative treatments may be necessary if the initial treatment is not effective 2, 3, 4.