What is the recommended treatment for supportive otitis media with a ruptured eardrum (tympanic membrane perforation)?

From the Guidelines

The recommended treatment for supportive otitis media with a ruptured eardrum includes oral antibiotics, pain management, and keeping the ear dry, with ciprofloxacin and hydrocortisone ear drops being a suitable option for patients with significant drainage, as indicated by 1 and 1. When considering treatment for supportive otitis media with a ruptured eardrum, it's essential to prioritize the patient's morbidity, mortality, and quality of life.

• The primary goal is to manage the infection, alleviate pain, and promote healing of the perforation.
• Oral antibiotics, such as amoxicillin-clavulanate, are typically the first-line treatment, but alternatives like ciprofloxacin may be considered for penicillin-allergic patients, as mentioned in the example answer.
• Pain management can be achieved with acetaminophen or ibuprofen, and patients should be advised to keep the affected ear dry by using earplugs or cotton balls coated with petroleum jelly when showering.
• For patients with significant drainage, antibiotic ear drops like ciprofloxacin with hydrocortisone may be prescribed, applied 3-4 drops twice daily for 7-10 days, as suggested by 1 and 1.
• It's crucial to follow up with patients to ensure resolution of the infection and healing of the perforation, typically scheduled 2-3 weeks after initial treatment. Key considerations in treatment include:
• Avoiding water entry into the ear canal to prevent further infection
• Avoiding insertion of objects into the ear canal, including cotton-tipped swabs
• Using pain-relieving medications as needed, under the guidance of a healthcare professional
• Monitoring for potential side effects of eardrops, such as local rash, itching, or irritation, as noted in 1 and 1.

From the FDA Drug Label

The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.

The FDA drug label does not answer the question about Ciprofloxacin+hydrocortisone treatment for supportive otitis media with a ruptured eardrum. However, ofloxacin (OTIC) is recommended for Chronic Suppurative Otitis Media with perforated tympanic membranes at a dose of 10 drops (0.5 mL, 1.5 mg ofloxacin) twice daily for 14 days in patients 12 years and older 2.

Key points:

• Drug: ofloxacin (OTIC)
• Indication: Chronic Suppurative Otitis Media with perforated tympanic membranes
• Dosage: 10 drops (0.5 mL, 1.5 mg ofloxacin) twice daily for 14 days
• Age: 12 years and older
• Note: This is not directly related to the question about Ciprofloxacin+hydrocortisone treatment.

From the Research

Treatment for Supportive Otitis Media with Ruptured Eardrum

The recommended treatment for supportive otitis media with a ruptured eardrum (tympanic membrane perforation) involves the use of topical antibiotics. Key points to consider include:

• The use of ciprofloxacin and hydrocortisone as a treatment option 3, 4
• The efficacy of ciprofloxacin in treating otitis media with tympanostomy tubes or perforated tympanic membranes 5, 6, 7
• The importance of considering the potential for ototoxicity when selecting a treatment option 5, 6

Efficacy of Ciprofloxacin and Hydrocortisone

Studies have shown that ciprofloxacin and hydrocortisone are effective in treating supportive otitis media with a ruptured eardrum. Specifically:

• A study published in 2006 found that topical ciprofloxacin/dexamethasone otic suspension was superior to oral amoxicillin/clavulanic acid suspension in children with acute otitis media with otorrhea through tympanostomy tubes 3
• A study published in 2017 found that the combination of ciprofloxacin plus fluocinolone was more effective than treatment with ciprofloxacin or fluocinolone alone for acute otitis media with tympanostomy tubes in children 4

Safety and Tolerability

The safety and tolerability of ciprofloxacin and hydrocortisone have been evaluated in several studies. Key findings include:

• Topical ciprofloxacin has been shown to be well tolerated, with minimal systemic absorption and a low risk of adverse events 5, 6
• The combination of ciprofloxacin plus fluocinolone has been found to be safe and well tolerated in children, with a low incidence of adverse events related to study medication 4