What is the treatment for otitis externa?

From the Guidelines

The treatment for otitis externa typically involves cleaning the ear canal, controlling pain, and addressing the infection with topical antibiotic ear drops, often combined with steroids to reduce inflammation, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1.

Key Components of Treatment

• Gentle cleaning of the ear canal by a healthcare provider to remove debris that can prevent topical medications from working effectively
• Topical antibiotic ear drops, such as ciprofloxacin with dexamethasone (Ciprodex), ofloxacin, or neomycin-polymyxin B-hydrocortisone drops, administered as 3-4 drops in the affected ear(s) 3-4 times daily for 7-10 days
• Pain management with acetaminophen or ibuprofen
• Keeping the ear dry by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly during showers

Special Considerations

• Patients with diabetes, an immunocompromised state, or both require special consideration, as they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1
• Concurrent middle ear disease can modify treatment of AOE, and patients with a tympanostomy tube or tympanic membrane perforation may develop diffuse AOE due to purulent middle-ear secretions that enter the external ear canal 1

Prevention

• Preventing AOE includes removing obstructing cerumen, using acidifying ear drops, drying the ear canal with a hair dryer, using ear plugs while swimming, and avoiding trauma to the external auditory canal 1

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Otitis Externa 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. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. INDICATIONS AND USAGE Ofloxacin otic solution 0.3% is indicated for the treatment of infections caused by susceptible isolates of the designated microorganisms in the specific conditions listed below: Otitis Externa in adults and pediatric patients, 6 months and older, due to Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus.

The treatment for otitis externa is ofloxacin otic solution 0.3%. The recommended dosage is:

• For pediatric patients (from 6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for 7 days.
• For patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear once daily for 7 days 2. It is indicated for the treatment of infections caused by susceptible isolates of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus in patients 6 months and older 2.

From the Research

Treatment Options for Otitis Externa

• The treatment of otitis externa typically involves the use of topically applied broad-spectrum antibiotics, such as ofloxacin otic solution 3, 4.
• Studies have shown that ofloxacin otic solution is effective in achieving clinical and microbiologic cure of otitis externa, with cure rates ranging from 80% to 95% 3, 4.
• Other treatment options include the use of otic powders, such as Auricularum, which have been shown to promote earlier healing and pain relief compared to otic drops 5.
• The use of ciprofloxacin as an ear drop has also been shown to be effective in the treatment of otitis externa, with rapid eradication of bacterial pathogens and marked clinical improvement 6.

Comparison of Treatment Options

• A study comparing the efficacy of ofloxacin otic solution to neomycin sulfate/polymyxin B sulfate/hydrocortisone solution found that ofloxacin was as effective and well tolerated as the standard of care 3.
• Another study found that an aminoglycoside antibiotic conveyed no significant benefit in the treatment of otitis externa, suggesting that topical antibiotics may not be necessary in all cases 7.
• A comparison of otic powder and otic drops found that the otic powder promoted earlier healing and pain relief, with a higher probability of healing within 7 days 5.

Safety and Efficacy

• Ofloxacin otic solution has been shown to be well tolerated, with minor adverse events experienced by only 3% of patients 3.
• The use of ciprofloxacin as an ear drop has also been shown to be safe, with no adverse effects noted in one study 6.
• The efficacy and safety of ofloxacin otic solution make it a valuable treatment option for otitis externa, particularly in patients with non-intact tympanic membranes 4.