What are the best otic drops for treating otitis externa?

From the Guidelines

The best otic drops for treating otitis externa are typically combination products containing an antibiotic and a steroid, such as ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex) or neomycin-polymyxin B-hydrocortisone. These should be used 3-4 drops in the affected ear twice daily for 7-10 days, as recommended by the clinical practice guideline for acute otitis externa 1. Before applying drops, the ear canal should be gently cleaned of debris if possible, using methods such as gentle lavage with body-temperature water, saline solution, or hydrogen peroxide, or physically removing the obstructing debris with suction or dry mop (blotting with cotton-tipped applicator) 1. For severe cases with significant canal swelling, an ear wick may be inserted to facilitate medication delivery. Acidifying agents like 2% acetic acid solutions (such as VoSol) can also be effective, especially for mild cases or those with suspected fungal involvement, as they help to reduce the pH of the ear canal and create an environment less conducive to bacterial growth 1. Pain management with oral analgesics is often necessary during the first few days of treatment. These combination drops work by addressing both the infection (through the antibiotic component) and the inflammation (through the steroid component), which helps resolve symptoms more quickly than either agent alone. Patients should avoid getting water in the ear during treatment and should complete the full course of drops even if symptoms improve earlier to prevent recurrence, as recommended by the clinical practice guideline for acute otitis externa 1. Key considerations in the management of otitis externa include the use of topical antimicrobials, which are beneficial for treating the condition, while oral antibiotics have limited utility and may contribute to the development of antibiotic resistance 1. The choice of otic drops should be guided by the suspected or confirmed causative pathogens, with Pseudomonas aeruginosa and Staphylococcus aureus being the most common bacterial causes of otitis externa 1. In general, the treatment of otitis externa should prioritize the use of topical therapy, with oral antibiotics reserved for severe cases or those with significant comorbidities, as recommended by the clinical practice guideline for acute otitis externa 1. Some key points to consider when treating otitis externa include:

• The importance of gentle cleaning of the ear canal before applying drops
• The use of combination products containing an antibiotic and a steroid
• The potential benefits of acidifying agents in mild cases or those with suspected fungal involvement
• The need for pain management with oral analgesics during the first few days of treatment
• The importance of completing the full course of drops even if symptoms improve earlier to prevent recurrence.

From the FDA Drug Label

1 INDICATIONS AND USAGE 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.

14 CLINICAL STUDIES In a randomized, multi-center, evaluator-blinded study of patients with acute otitis externa, patients were treated with either ciprofloxacin otic solution, 0.2% twice daily or neomycin and polymyxin B sulfates and hydrocortisone otic solution (PNH) three times daily for 7 days. In the per protocol population, clinical cure was achieved at the end of a 7-day treatment in 70% (173/247) for the ciprofloxacin otic solution, 0.2% treated group versus 60% (147/243) for the control treated group.

The best otic drops for treating otitis externa include ciprofloxacin (OTIC), as it has shown a clinical cure rate of 70% in a randomized study 2. Another option is ofloxacin (OTIC), which is also used to treat otitis externa, although its effectiveness is not directly compared to ciprofloxacin in the provided studies. Key points to consider when choosing otic drops for otitis externa include:

• Indication: Ciprofloxacin otic solution, 0.2% is indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 2.
• Dosage: The recommended dosage regimen for ciprofloxacin otic solution, 0.2% is twice daily for 7 days, while ofloxacin otic solution has a recommended dosage regimen of once daily for 7 days for patients 13 years and older 3.

From the Research

Otitis Externa Drops

• The best otic drops for treating otitis externa include ofloxacin otic solution, which has been shown to be effective in achieving clinical and microbiologic cure of otitis externa 4, 5, 6, 7, 8.
• Ofloxacin otic solution has been compared to other treatments, such as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension, and has been found to be as effective and well-tolerated 4, 6, 8.
• The efficacy of ofloxacin otic solution has been demonstrated in both children and adults, with cure rates ranging from 82% to 97% in clinically evaluable patients 4, 6, 8.
• Ofloxacin otic solution has also been shown to be effective against a broad spectrum of organisms, including Pseudomonas aeruginosa and Staphylococcus aureus 4, 5, 6.
• The use of ofloxacin otic solution has several advantages, including once-daily dosing, which may improve patient adherence, and a lack of ototoxicity, which makes it a safe option for patients with undiagnosed tympanic membrane perforation 4, 5, 7.

Comparison of Otic Drops

• Ofloxacin otic solution has been compared to other otic preparations, such as ciprofloxacin otic, and has been found to be as effective in curing otitis externa 7.
• The efficacy of ofloxacin otic solution has also been compared to oral antibiotics, such as amoxicillin/clavulanic acid, and has been found to be effective in the treatment of otitis media in patients with tympanic membrane perforations or tympanostomy tubes 5.

Safety and Tolerability

• Ofloxacin otic solution has been found to be well-tolerated, with minor adverse events, such as pruritus and application-site reactions, reported in a small percentage of patients 4, 5, 6, 8.
• The lack of ototoxicity associated with ofloxacin otic solution makes it a safe option for patients with undiagnosed tympanic membrane perforation 5, 7.