What is the recommended treatment for swimmer's ear using fluoroquinolone (FQ) drops, such as ciprofloxacin (Cipro) or ofloxacin?

From the Guidelines

For swimmer's ear (otitis externa), the recommended treatment with fluoroquinolone drops involves applying 3-4 drops of ciprofloxacin or ofloxacin into the affected ear canal twice daily for 7-10 days, as this regimen has been shown to be effective in treating the infection while minimizing the risk of complications and promoting a faster recovery 1.

Key Considerations for Treatment

• Before application, gently clean the outer ear canal of any debris and dry it thoroughly to ensure the drops can penetrate effectively.
• Tilt your head with the affected ear facing upward, pull the outer ear gently upward and backward (for adults) or downward and backward (for children) to straighten the ear canal, then instill the drops.
• Maintain this position for 1-2 minutes to allow the medication to penetrate deeply into the ear canal.
• Fluoroquinolone drops are effective because they provide broad-spectrum antimicrobial coverage against the common bacteria that cause swimmer's ear, including Pseudomonas aeruginosa and Staphylococcus species, by inhibiting bacterial DNA replication 1.

Management and Follow-Up

• During treatment, keep the ear dry by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly when showering to prevent further irritation and infection.
• If symptoms worsen or don't improve after 48-72 hours, consult a healthcare provider as additional treatments may be necessary, including potential oral antibiotics or further cleaning of the ear canal 1.
• It's also important to note that while fluoroquinolone drops are generally safe and well-tolerated, some people may experience local side effects such as rash, itching, or discomfort, and rare but serious side effects can occur, emphasizing the need for medical supervision 1.

From the FDA Drug Label

For an Ear Canal Infection (“Swimmer’s Ear”): The person receiving ofloxacin otic solution should lie on his/her side with the infected ear up Patients (13 and older) should have 10 drops of ofloxacin otic solution put into the infected ear. Pediatric patients under 13 should have 5 drops put into the infected ear. In patients with an Ear Canal Infection (“Swimmer’s Ear”), ofloxacin otic solution ear drops should be given once daily at about the same time each day (for example, 8 AM or 8 PM) in each infected ear unless the doctor has instructed otherwise

The recommended treatment for swimmer's ear using ofloxacin (FQ) drops is to administer 10 drops for patients 13 and older and 5 drops for pediatric patients under 13, once daily at the same time each day, unless instructed otherwise by a doctor 2.

From the Research

Treatment of Swimmer's Ear with Fluoroquinolone Drops

The treatment of swimmer's ear, also known as otitis externa, with fluoroquinolone (FQ) drops is a common practice. The following are some key points to consider:

• Fluoroquinolone drops, such as ciprofloxacin (Cipro) or ofloxacin, are effective in treating otitis externa 3, 4.
• These drops have been shown to have a high cure rate, with studies reporting rates of 83.3% to 100% for all pathogens commonly isolated from middle ear effusions in cases of otitis media and otitis externa 3.
• The use of topical FQ drops is recommended by the American Academy of Otolaryngology-Head and Neck Surgery, as they offer excellent efficacy, decreased risk of systemic side effects, and less likelihood of selecting for resistant strains of microorganisms 4.
• Ciprofloxacin 0.3%/dexamethasone 0.1% topical drops (Ciprodex) are a commonly used treatment for otic infections, and have been shown to be effective in several large prospective clinical trials 4.
• Ofloxacin otic solution 0.3% has been shown to be clinically effective in the treatment of otitis externa, with a low rate of adverse drug reactions and no reports of ototoxicity 3, 5, 6.
• However, the use of ciprofloxacin drops to treat ciprofloxacin-resistant bacteria is ineffective, and patients do significantly better with alternative therapy 7.

Key Considerations

• The choice of FQ drop and treatment regimen should be based on the severity of the infection, the presence of any underlying medical conditions, and the patient's age and weight.
• Patients should be instructed to use the drops as directed, and to complete the full course of treatment to ensure optimal efficacy.
• The use of FQ drops should be monitored for any signs of adverse reactions or resistance, and alternative treatments should be considered if necessary.

Treatment Regimens

• Ciprofloxacin 0.3%/dexamethasone 0.1% topical drops (Ciprodex) can be used for the treatment of otic infections, including otitis externa and middle ear infections 4.
• Ofloxacin otic solution 0.3% can be used for the treatment of otitis externa, and can be administered once daily for 7-10 days 3, 5, 6.