What ear drops are safe to use for swimmer's ear in a patient with tympanostomy (ear) tubes?

From the Guidelines

For patients with tympanostomy tubes who develop swimmer's ear, fluoroquinolone ear drops such as ciprofloxacin (Ciprodex, Cetraxal) or ofloxacin (Floxin Otic) are the recommended treatment option, as they are non-ototoxic and safe for use with ear tubes 1.

Key Considerations

• These drops are typically used 3-4 times daily for 7-10 days, and it's essential to avoid using aminoglycoside-containing drops like neomycin or gentamicin, as they can cause hearing loss if they reach the inner ear through the tubes 1.
• Alcohol-based drops should also be avoided, as they can cause pain and irritation.
• When applying the drops, the patient should lie with the affected ear upward for 3-5 minutes to allow proper penetration.
• If symptoms don't improve within 48-72 hours or if there's increasing pain, drainage, or fever, medical reevaluation is necessary.

Important Safety Information

• Topical antibiotic therapy with fluoroquinolone drops has been shown to have superior outcomes compared to systemic oral antibiotics, with improved clinical cure rates and reduced adverse events 1.
• Caregivers should be advised to limit topical therapy to a single course of no more than 10 days to minimize the risk of ototoxicity and antimicrobial resistance.
• Cleaning the ear canal of any debris or discharge before administering the drops can help improve the effectiveness of the treatment 1.

From the FDA Drug Label

Ofloxacin Otic Solution is an antibiotic in a sterile solution used to treat ear infections caused by certain bacteria found in: ... patients (6 months and older) who have an infection in the ear canal An ear canal infection (also known as "Swimmer's Ear") is a bacterial infection of the ear canal. 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

Ofloxacin Otic Solution is safe to use for swimmer's ear in patients with tympanostomy (ear) tubes. The recommended dosage is 10 drops for patients 13 and older, and 5 drops for pediatric patients under 13, given once daily 2.

From the Research

Ear Drops for Swimmer's Ear with Ear Tubes

• The following ear drops are safe to use for swimmer's ear in patients with tympanostomy (ear) tubes:
  • Ciprofloxacin/dexamethasone otic suspension 3, 4, 5
  • Ofloxacin otic solution 6, 7
• These ear drops have been shown to be effective in treating acute otitis media with otorrhea through tympanostomy tubes in pediatric patients.

Comparison of Ear Drops

• Ciprofloxacin/dexamethasone otic suspension has been shown to be superior to ofloxacin otic solution in the treatment of children with acute otitis media with otorrhea through tympanostomy tubes 7
• Ciprofloxacin/dexamethasone otic suspension has also been shown to be superior to oral amoxicillin/clavulanic acid suspension in the treatment of children with acute otitis media with otorrhea through tympanostomy tubes 5
• Ofloxacin otic solution has been shown to be as effective as systemic therapy with Augmentin oral suspension in treating acute otitis media with otorrhea through tympanostomy tubes in children 6

Safety and Tolerability

• Both ciprofloxacin/dexamethasone otic suspension and ofloxacin otic solution have been shown to be safe and well tolerated in pediatric patients 3, 4, 5, 6, 7
• The most common adverse events associated with these ear drops include ear pain, diarrhea, dermatitis, and gastroenteritis 3, 4, 5, 6