What is the recommended treatment for otitis externa?

From the Guidelines

The recommended treatment for otitis externa typically involves cleaning the ear canal, followed by topical antimicrobial therapy, as outlined in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1.

Key Components of Treatment

• Gentle cleaning of the ear canal to remove debris that can block medication penetration
• Topical antimicrobial therapy with antibiotic ear drops containing fluoroquinolones (such as ciprofloxacin or ofloxacin) or aminoglycosides (like neomycin) combined with a steroid (such as hydrocortisone)
• Application of ear drops 3-4 times daily for 7-10 days
• Use of an ear wick if significant swelling prevents drops from entering the canal
• Pain management with oral analgesics like acetaminophen or ibuprofen
• Avoidance of water exposure during treatment and avoidance of using cotton swabs, which can push debris deeper and traumatize the canal

Important Considerations

• The treatment approach should address both the infection (with antibiotics) and inflammation (with steroids), while cleaning ensures the medication can reach the affected areas 1
• Patients with diabetes, an immunocompromised state, or both require special consideration, as they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1
• Concurrent middle ear disease can modify treatment of AOE, and patients with a tympanostomy tube or tympanic membrane perforation may develop diffuse AOE because of purulent middle-ear secretions that enter the external ear canal 1

Patient Education

• Patients should be informed about the importance of completing the full course of treatment, even if symptoms improve before the end of the treatment period 1
• Patients should also be advised to avoid scratching or touching the ear and to avoid inserting anything into the ear canal, including cotton-tipped swabs 1

From the FDA Drug Label

DOSAGE AND ADMINISTRATION 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 (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days.

The recommended treatment for otitis externa is:

• For pediatric patients (from 6 months to 13 years old): 5 drops of ofloxacin instilled into the affected ear once daily for 7 days.
• For patients 13 years and older: 10 drops of ofloxacin instilled into the affected ear once daily for 7 days 2.

From the Research

Otitis Externa Treatment

The recommended treatment for otitis externa includes:

• Topical antibiotics, such as ofloxacin otic solution, which has been shown to be effective in achieving clinical and microbiologic cure of otitis externa 3, 4, 5
• Aural toilet and topical preparations containing antibiotic/antifungal and steroid preparations 6
• Treatment regimens, such as ciprofloxacin (2 mg/ml) as ear drops twice daily or drops containing oxytetracycline (5 mg/ml) polymyxin B (10,000 units/ml) and hydrocortisone (15 mg/ml) twice daily for 7 days 7

Key Findings

• Ofloxacin otic solution 0.3% has been shown to be as effective as topical neomycin/polymixin B/hydrocortisone preparations in the treatment of otitis externa, with a clinical cure rate of over 80% in adults and over 95% in children 4
• Ciprofloxacin has been found to be a useful and effective agent in the local therapy of otitis externa, with rapid eradication of all bacterial pathogens and marked clinical improvement 7
• The use of topical antibiotics, such as ofloxacin otic solution, has been found to be well tolerated, with minimal adverse effects and no ototoxicity 3, 4, 5

Treatment Considerations

• The choice of treatment for otitis externa should be based on the severity of the infection and the presence of any underlying conditions, such as a perforated tympanic membrane 4, 5
• Topical antibiotics, such as ofloxacin otic solution, may be preferred over oral antibiotics due to their high concentrations in the ear and minimal systemic absorption 4, 5
• The effectiveness of topical antibiotics in the treatment of otitis externa may be influenced by factors, such as the type of pathogen involved and the presence of any resistant strains 3, 5