What ear drops are recommended for an ear infection with tympanostomy (ear) tubes?

From the Guidelines

For ear infections with tympanostomy tubes, antibiotic ear drops, specifically fluoroquinolone drops like ciprofloxacin or ofloxacin, are recommended as the first line of treatment, administered as 3-4 drops in the affected ear twice daily for 7-10 days. This recommendation is based on the most recent and highest quality study available, which prioritizes the reduction of morbidity, mortality, and improvement of quality of life 1. The use of these drops is preferred because they can directly reach the infection site through the tubes, thereby effectively treating the infection while minimizing systemic side effects associated with oral antibiotics.

Key Points for Treatment:

• Fluoroquinolone drops, such as ciprofloxacin (Ciprodex, Cetraxal) or ofloxacin (Floxin Otic), are the preferred choice for treating ear infections with tympanostomy tubes.
• Administration should be 3-4 drops in the affected ear, twice daily, for a duration of 7-10 days.
• Before applying the drops, gently clean the outer ear, especially if drainage is present, to ensure the medication reaches the infection site effectively.
• The head should be tilted to the side with the affected ear facing up, and the outer ear should be gently pulled to straighten the ear canal, keeping the head tilted for 1-2 minutes after application.
• Aminoglycoside drops, like neomycin/polymyxin B/hydrocortisone combinations, may also be used but carry a small risk of hearing loss and are not the first choice due to potential ototoxicity.

Rationale:

The rationale behind using topical antibiotic therapy, such as fluoroquinolone drops, is that it avoids the adverse events associated with systemic antibiotics, including dermatitis, allergic reactions, gastrointestinal upset, oral thrush, and the potential for increased antibiotic resistance 1. Moreover, these drops can achieve high concentrations at the site of infection, which is crucial for overcoming potential resistance and ensuring the effectiveness of the treatment.

Additional Considerations:

• Caregivers should be advised to limit topical therapy to a single course of no more than 10 days to avoid prolonged or frequent use that may lead to fungal external otitis.
• Systemic antibiotic therapy is not recommended for first-line treatment of uncomplicated acute tympanostomy tube otorrhea (TTO) but may be considered in cases of severe infection, concurrent bacterial infections, or when topical therapy fails 1.
• Cleaning the ear canal before administering drops and using techniques like "pumping" the tragus can aid in the delivery of the medication to the middle ear space, enhancing the effectiveness of the treatment.

From the FDA Drug Label

The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (age 6 months and older) through tympanostomy tubes is: Four drops (0. 14 mL, 0.42 mg ciprofloxacin, 0. 14 mg dexamethasone) instilled into the affected ear twice daily for seven days. The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (from one to 12 years old) with tympanostomy tubes is: Five drops (0.25 mL, 0. 75 mg ofloxacin) instilled into the affected ear twice daily for ten days.

The recommended ear drops for an ear infection with tympanostomy (ear) tubes are:

• CIPRODEX® Otic (ciprofloxacin and dexamethasone) 2: 4 drops, twice daily for 7 days
• ofloxacin (OTIC) 3: 5 drops, twice daily for 10 days Key points:
• Always follow the recommended dosage regimen
• Warm the solution by holding the bottle in the hand for 1-2 minutes before use
• Instill the drops into the affected ear with the patient lying with the affected ear upward
• Pump the tragus to facilitate penetration of the drops into the middle ear

From the Research

Ear Drops for Ear Infection with Tympanostomy Tubes

• The use of antibiotic/anti-inflammatory combination ear drops is supported by the literature for the treatment of acute otitis media with tympanostomy tubes in pediatric patients 4.
• Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension has been demonstrated to be safe and effective in treating ear infections in pediatric patients with tympanostomy tubes, with low treatment failure rates 4, 5, 6, 7.
• Topical ciprofloxacin/dexamethasone otic suspension has been shown to be superior to oral amoxicillin/clavulanic acid suspension in treating acute otitis media with otorrhea through tympanostomy tubes, with a shorter median time to cessation of otorrhea and more clinical cures 5.
• The combination of ciprofloxacin plus fluocinolone has also been found to be more effective than treatment with ciprofloxacin or fluocinolone alone for acute otitis media with tympanostomy tubes, and is safe and well tolerated in children 8.
• Topical ciprofloxacin/dexamethasone treatment has been shown to be superior to topical ofloxacin in the treatment of acute otitis media with otorrhea through tympanostomy tubes, with a higher clinical cure rate and shorter median time to cessation of otorrhea 6.
• The addition of a corticosteroid to topical antibiotic drops has been found to improve resolution of acute tympanostomy tube otorrhea, with a faster clinical resolution and shorter time to cessation of otorrhea 7.