Is Ciprodex (Ciprofloxacin and Dexamethasone) therapy for 19 days an appropriate treatment duration?

From the Guidelines

Ciprodex (Ciprofloxacin and Dexamethasone) therapy for 19 days is not an appropriate treatment duration, as the recommended duration is typically limited to 7-10 days to minimize the risk of adverse effects and promote optimal outcomes. According to the clinical practice guideline on tympanostomy tubes in children, updated in 2022 1, topical antibiotic therapy, such as Ciprodex, has been shown to be effective in treating acute tympanostomy tube otorrhea (TTO), with clinical cure rates ranging from 77% to 96% after 7 to 10 days of treatment. The guideline recommends limiting topical therapy to a single course of no more than 10 days to avoid potential ototoxicity and other adverse effects. Some key points to consider when using Ciprodex include:

• The importance of cleaning the ear canal before administering the drops to ensure effective delivery of the medication
• The potential for prolonged or frequent use of quinolone eardrops to be a causative factor in otomycosis
• The need for caregivers to be advised to limit topical therapy to a single course of no more than 10 days
• The possibility that children who fail topical therapy may require further cleaning of the ear canal or suctioning of the tube lumen to facilitate drug delivery. Given the potential risks associated with prolonged use of Ciprodex, it is essential to follow the recommended treatment duration and consult with a healthcare provider if symptoms persist or worsen over time 1.

From the Research

Treatment Duration of Ciprodex (Ciprofloxacin and Dexamethasone)

• The standard treatment duration of Ciprodex is typically 7 days, as seen in studies 2, 3, 4.
• There is no evidence to support a 19-day treatment duration with Ciprodex.
• Studies have shown that Ciprodex is effective in treating acute otitis media with otorrhea through tympanostomy tubes, with significant improvements in clinical signs and symptoms after 7 days of treatment 2, 3, 4.
• The addition of dexamethasone to ciprofloxacin has been shown to improve clinical outcomes, including faster cessation of otorrhea and improved bacterial eradication rates 3, 4, 5.
• Prolonged use of Ciprodex beyond the recommended 7-day treatment duration may increase the risk of adverse effects, although the current evidence does not provide information on the safety of extended treatment durations.