From the Guidelines
For a 12-year-old pediatric patient with acute otitis externa, I strongly recommend using topical ear drops alone as the most effective treatment, which may contain antibiotics, antiseptics, steroids, or a combination, without the need for oral antibiotics unless the infection spreads beyond the ear canal or the patient has a weakened immune system. When selecting an eardrop, it's essential to consider factors such as cost, dosing frequency, and the patient's medical history, including any prior ear surgery or presence of an eardrum perforation 1. The patient should use the eardrops for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection, and notify their doctor if symptoms persist beyond 7 days 1. To manage pain, especially in the first few days, the patient can use pain medicine such as acetaminophen or ibuprofen, as recommended by their doctor 1. It's crucial to avoid scratching or touching the ear, inserting anything into the ear canal, and to cover the ear canal with an earplug or cotton with petroleum jelly before showering or hair washing to minimize water entry 1. The patient should also check with their doctor regarding swimming or other water activities during or after the infection 1. By following this treatment approach, most patients can expect to feel better within 48 to 72 hours and have minimal or no symptoms by 7 days 1.
From the FDA Drug Label
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. The treatment for acute otitis externa in a 12-year-old pediatric patient is ofloxacin (OTIC), with a recommended dosage of five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days 2.
- The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness.
- The patient should lie with the affected ear upward, and then the drops should be instilled.
- This position should be maintained for five minutes to facilitate penetration of the drops into the ear canal.
From the Research
Treatment for Acute Otitis Externa
The treatment for acute otitis externa in a 12-year-old pediatric patient typically involves:
- Topical therapy with acidifying and antimicrobial agents 3
- Topical antibiotic and steroid preparations 4, 5, 6
- Systemic antimicrobial therapy may be indicated in some cases, but is rarely needed 3, 6
- Debridement and ear cleaning may also be necessary 3, 4
Topical Treatments
Some studies have compared the efficacy of different topical treatments, including:
- Topical antimicrobials containing steroids, which were found to be significantly more effective than placebo drops 4
- Acetic acid, which was found to be effective and comparable to antibiotic/steroid at week 1, but less effective when treatment needed to be extended beyond this point 4
- Otic powder preparations, such as Auricularum, which were found to promote earlier healing and pain relief than otic drops 5
- Ofloxacin otic, which was found to be as effective as other otic preparations, such as polymyxin/neomycin plus hydrocortisone and ciprofloxacin otic, in curing otitis externa in children 7
Considerations
When choosing a topical treatment, considerations should include: