What is the best ear drop for treating otitis externa?

From the Guidelines

The best ear drop for treating otitis externa is typically a combination product containing an antibiotic and a steroid, such as ciprofloxacin 0.3% and dexamethasone 0.1% (Ciprodex) or neomycin-polymyxin B-hydrocortisone, as all eardrops approved for treating AOE are highly effective with no consistent advantage shown for any one specific drug 1. When selecting an ear drop, factors such as cost, dosing frequency, status of the eardrum, and the doctor’s experience should be considered, as well as the patient's opinion and preferences 1. Some key points to consider when using ear drops for otitis externa include:

• Using the ear drops for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection 1
• Avoiding scratching or touching the ear and not inserting anything into the ear canal, including cotton-tipped swabs, to minimize the risk of further irritation or infection 1
• Covering the opening of the ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry 1
• Notifying the doctor if pain or other symptoms fail to respond within 48 to 72 hours, or if symptoms persist beyond 7 days 1 It is also important to note that eardrops are, in general, very safe and well tolerated, but some people may report local rash, itching, irritation, or discomfort, and patients should inform their doctor if they experience any of these side effects or if they have a history of ear surgery, perforation of the eardrum, or ear tube placement 1.

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. Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. 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.

The best ear drop for treating otitis externa is not explicitly stated in the provided drug labels, as each label presents a different medication. However, the following options are indicated for the treatment of otitis externa:

• Ciprofloxacin and dexamethasone otic suspension 2
• Ciprofloxacin otic solution, 0.2% 3
• Ofloxacin otic solution 4 It is essential to consult a healthcare professional to determine the most suitable treatment option based on the specific condition and patient needs.

From the Research

Treatment Options for Otitis Externa

• Otitis externa is an infection of the external auditory canal that can be treated with topically applied broad-spectrum antibiotics 5.
• Various ear drops are available for the treatment of otitis externa, including ofloxacin otic solution, ciprofloxacin, and combinations of oxytetracycline, polymyxin B, and hydrocortisone 6, 7.

Efficacy of Ofloxacin Otic Solution

• Ofloxacin otic solution 0.3% has been shown to be effective in the treatment of otitis externa, with clinical cure rates of over 80% in adults and over 95% in children 7.
• A study comparing ofloxacin otic solution to a combination of neomycin, polymyxin B, and hydrocortisone found that ofloxacin was as effective and better tolerated 5.
• Ofloxacin otic solution has also been shown to be effective in the treatment of chronic suppurative otitis media and otitis media with perforated tympanic membranes 7, 8.

Comparison to Other Treatments

• Ciprofloxacin has been shown to be effective in the treatment of otitis externa, with rapid eradication of bacterial pathogens and marked clinical improvement 6.
• A comparison of ofloxacin otic solution to ciprofloxacin otic found that both treatments were effective, but ofloxacin may have an advantage due to its less frequent dosing regimen 9.
• Combinations of oxytetracycline, polymyxin B, and hydrocortisone have also been used to treat otitis externa, but may have a higher risk of adverse effects and ototoxicity 6, 7.

Safety and Tolerability

• Ofloxacin otic solution 0.3% has been shown to be well tolerated, with minimal systemic absorption and a low risk of adverse effects 7.
• The most common adverse effects associated with ofloxacin otic solution are bitter taste and pruritus, which are typically mild to moderate in severity 7.
• Ofloxacin otic solution has been found to be non-ototoxic and non-chondrotoxic, making it a safe option for use in patients with perforated tympanic membranes or tympanostomy tubes 7, 9.