What is the recommended otic (ear) drop for treating otitis externa?

From the Guidelines

The most effective treatment for otitis externa involves using eardrops that contain antibiotics, antiseptics, steroids, or a combination, with no single specific drug showing a consistent advantage over others 1. When selecting an otic drop for treating otitis externa, it's crucial to consider factors such as cost, dosing frequency, the status of the eardrum, and the doctor's experience, as well as the patient's preferences and any history of ear surgery or sensitivity to certain medications 1. The recommended treatment duration is typically at least 7 days, even if symptoms improve sooner, to prevent relapse of infection, and patients should be advised to avoid scratching or touching the ear, inserting objects into the ear canal, and to cover the ear canal when showering or washing hair to minimize water entry 1. Key benefits of proper treatment include reducing pain, identifying potential misdiagnosis, and preventing complications from delayed management. In terms of specific products, combination otic drops such as ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex) or neomycin-polymyxin B-hydrocortisone are commonly used, with the standard regimen involving 3-4 drops instilled into the affected ear canal three to four times daily for 7-10 days. Before application, gently cleaning the ear canal of debris, if possible, and proper administration techniques, such as lying with the affected ear upward and maintaining this position for 1-2 minutes after instillation, are recommended to ensure the medication reaches the ear canal effectively 1. It's also important for patients to complete the full course of medication, even if symptoms improve earlier, and to avoid getting water in the ear during treatment. In cases of severe canal edema, an ear wick may be inserted by a healthcare provider to facilitate medication delivery. Overall, the goal of treatment is to effectively manage the infection, reduce symptoms, and prevent complications, with the choice of otic drop being tailored to the individual patient's needs and circumstances.

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.

The recommended otic drops for treating 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.

From the Research

Otic Drops for Otitis Externa

• The recommended otic drops for treating otitis externa include ofloxacin otic solution 0.3% 4, 5, ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension 6, and ciprofloxacin ear drops 7.
• Ofloxacin otic solution 0.3% has been shown to be effective in achieving clinical and microbiologic cure of otitis externa, with a cure rate of 91% among clinically evaluable patients 4.
• Ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension has been compared to neomycin/polymyxin B/hydrocortisone otic suspension and found to be clinically and microbiologically superior in the treatment of mild to severe otitis externa 6.
• Ciprofloxacin ear drops have also been shown to be effective in the local therapy of otitis externa, with rapid eradication of bacterial pathogens and marked clinical improvement 7.
• Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is also an effective treatment for otitis externa 8.

Comparison of Otic Drops

• Ofloxacin otic solution 0.3% and ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension have been compared to other otic drops, such as neomycin/polymyxin B/hydrocortisone otic suspension, and found to be effective and well-tolerated 4, 5, 6.
• Ciprofloxacin ear drops have been compared to oxytetracycline, polymyxin B, and hydrocortisone combination treatment and found to be effective in the local therapy of otitis externa 7.

Safety and Tolerability

• Ofloxacin otic solution 0.3% and ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension have been found to be well-tolerated, with minor adverse events such as pruritus and application-site reactions 4, 6.
• Ciprofloxacin ear drops have been found to be safe and effective, with no adverse effects noted 7.