What is the treatment for an outer ear infection?

From the Guidelines

The treatment for an outer ear infection (otitis externa) typically involves cleaning the ear canal and using topical medications, with antibiotic ear drops such as ofloxacin or ciprofloxacin with hydrocortisone being commonly prescribed, as recommended by the most recent clinical practice guideline 1. To manage the infection, start by keeping the ear dry and avoiding swimming or submerging your head underwater until the infection clears. Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort. For medication, antibiotic ear drops are usually administered as 3-4 drops in the affected ear 3-4 times daily for 7-10 days. Some key points to consider:

• For fungal infections, antifungal drops containing clotrimazole may be used instead.
• Proper application involves lying with the affected ear up, placing the drops, and remaining in that position for 3-5 minutes.
• A cotton ball may be placed loosely in the ear to prevent drops from leaking out.
• If significant swelling prevents drops from entering the ear canal, your doctor might insert a small wick to help deliver medication.
• Severe infections may require oral antibiotics. The infection typically improves within 2-3 days of starting treatment, but it is essential to complete the full course of medication to prevent recurrence, as emphasized in the clinical practice guideline 1.

From the FDA Drug Label

Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae.

The treatment for an outer ear infection may include amoxicillin (PO), as it is indicated for the treatment of upper respiratory tract infections, including those of the ear. However, it is essential to note that the specific type of infection and the causative organism should be considered when selecting a treatment. The dosage and administration of amoxicillin should be as directed by a healthcare professional, and treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained 2.

Alternatively, neomycin (TOP) may not be the first choice for treating outer ear infections due to the risk of ototoxicity and potential harm to the fetus if used during pregnancy 3.

From the Research

Outer Ear Infection Treatment

The treatment for an outer ear infection, also known as otitis externa, typically involves topical treatments.

• Topical treatment is the first-line treatment for inflammation of the external auditory canal and chronic otitis media, without the need of systemic antimicrobial drug therapy 4.
• The ear canal is cleaned mechanically, by rinsing with saline, and finally dried by suction 4.
• A bacterial or fungal culture specimen should be taken, if the inflammation does not heal with the first treatment or recurs rapidly 4.

Topical Treatments

• High local drug levels without systemic adverse effects are achieved with ear drops 4.
• A combinatorial broad-spectrum antibiotic/corticosteroid ear drop is the most effective remedy for bacterial inflammation, whereas the most important therapeutic procedure in fungal infections is cleaning and topical medication 4.
• Once-daily ofloxacin otic solution was as effective and safe as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension given four times daily in the treatment of otitis externa in children 5.
• The neomycin-polymyxin B association shows clear synergic effects against the pathogens commonly responsible for otitis externa 6.

Antibiotic Resistance

• The organisms most often causing otitis externa appear to be developing resistance to neomycin and polymyxin B but not to ofloxacin 7.
• The minimum inhibitory concentrations (MICs) of all bacterial isolates for neomycin and polymyxin B increased markedly in the 1999 to 2000 studies compared with the 1995 to 1996 studies 7.

Necessity of Topical Antibiotics

• A study suggests that an aminoglycoside antibiotic conveys no significant benefit in the treatment of otitis externa 8.
• The study found that patients receiving drops containing an aminoglycoside and steroid preparation had similar outcomes to those receiving the same preparation without the aminoglycoside 8.