From the Guidelines
Ciprofloxacin and dexamethasone ear drops can be used to treat a perforated tympanic membrane, but it is crucial to use them under close medical supervision and with caution, as the risk of ototoxicity exists, although the concentration of the antibiotic at the site of infection can be up to 1000 times higher than serum levels, typically overcoming resistance levels based on serum level cut points 1.
Key Considerations
- The use of ciprofloxacin and dexamethasone ear drops in cases of perforated tympanic membrane should be guided by an otolaryngologist (ENT specialist) to assess the extent of the perforation and the presence of infection 1.
- Topical antibiotic therapy, including ciprofloxacin and dexamethasone, has been shown to have superior outcomes compared to systemic oral antibiotics for treating acute tympanic tube otorrhea (TTO) in children, with clinical cure rates ranging from 77% to 96% 1.
- The high concentration of quinolone antibiotics at the site of infection can overcome resistance levels, but it is essential to limit topical therapy to a single course of no more than 10 days to minimize the risk of ototoxicity and other adverse events 1.
Treatment Approach
- Before administering ear drops, the ear canal should be cleaned of any debris or discharge to facilitate the entry of topical drops into the middle ear space 1.
- Caregivers should be advised on the proper use of ear drops and the importance of limiting the treatment course to minimize potential risks 1.
- In cases where topical therapy fails, further cleaning of the ear canal, suctioning of the tube lumen, or culture of persistent drainage may be necessary to guide future therapy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effects of Ciprofloxacin and Dexamethasone on Tympanic Membrane Perforation
- The effects of ciprofloxacin and dexamethasone on a perforated tympanic membrane have been studied in several research papers 2, 3, 4.
- These studies have shown that ciprofloxacin/dexamethasone delays the healing of tympanic membrane perforations, but does not cause persistent perforations 2, 3, 4.
- In one study, the isotonic sodium chloride solution control and ofloxacin-exposed tympanic membranes healed at similar rates, while there was a statistically significant delay in tympanic membrane healing in the ciprofloxacin-/dexamethasone-exposed tympanic membranes by postoperative Day 10 2.
- Another study found that ofloxacin did not delay healing relative to saline, while all other treatments, including ciprofloxacin and dexamethasone, delayed healing relative to ofloxacin at day 10 3.
- The combination of ciprofloxacin and dexamethasone was found to have a greater impact on delaying tympanic membrane healing than ofloxacin, and this effect was potentiated by steroids 3.
Comparison with Other Treatments
- A study comparing the efficacy of topical otic powder, tobramycin drops, and ciprofloxacin drops in patients with acute external otitis found that ciprofloxacin drops were effective in relieving symptoms quickly and efficiently 5.
- Another study found that ofloxacin otic drops shortened the closure time and improved the closure rate of large traumatic tympanic membrane perforations, but did not affect hearing improvement or increase the rate of middle ear infection 6.
Healing Rates and Times
- The healing rates and times of tympanic membrane perforations treated with ciprofloxacin and dexamethasone have been reported in several studies 2, 3, 4.
- One study found that all tympanic membrane perforations were healed by postoperative Day 20 in the ciprofloxacin-/dexamethasone-exposed group 2.
- Another study found that the closure rates of medium perforations between the ofloxacin drops-treated group and the observation group were not significantly different, but the ofloxacin drops-treated group had a significantly shorter closure time for medium perforations 6.