What are the discharge instructions and prescription recommendations for a patient with otitis externa?

Discharge Instructions for Otitis Externa

Topical antibiotic eardrops are the most effective treatment for acute otitis externa, and should be prescribed for 7 days along with detailed patient instructions on proper administration technique and pain management. 1

Medication Recommendations

Prescription Options

• First-line treatment: Fluoroquinolone-containing eardrops

  • Ciprofloxacin 0.3% with dexamethasone 0.1%: Four drops twice daily for 7 days 2
  • Ofloxacin 0.3%:
    • Adults and children ≥13 years: Ten drops once daily for 7 days
    • Children 6 months to 13 years: Five drops once daily for 7 days 3

• Alternative options (if tympanic membrane is intact):

  • Neomycin/polymyxin B/hydrocortisone preparations
  • Acetic acid preparations

Special Considerations

• For patients with perforated tympanic membrane or tympanostomy tubes, use only non-ototoxic preparations (fluoroquinolones) 1, 4
• Warm the eardrops by holding the bottle in hand for 1-2 minutes before administration to prevent dizziness 2, 3

Administration Instructions

1. Proper positioning:

   • Lie down with the affected ear upward
   • Have someone else administer drops if possible
   • Fill ear canal completely with prescribed number of drops
   • Maintain position for 3-5 minutes (use a timer)
   • Use gentle to-and-fro movement of the ear or press the tragus to help medication penetrate 1

2. Duration of treatment:

   • Continue using eardrops for the full 7 days, even if symptoms improve sooner
   • If symptoms persist beyond 7 days, continue drops and notify your doctor (maximum additional 7 days) 1

Pain Management

• Most patients feel better within 48-72 hours of starting eardrops
• For pain relief during first few days:
  • Use oral acetaminophen or NSAIDs as directed
  • Anesthetic eardrops are not recommended as they can mask symptoms 1, 5

Activity Restrictions and Precautions

1. Keep ear dry:

   • Cover ear canal with petroleum jelly-coated cotton or earplugs before showering or hair washing
   • Avoid swimming until infection resolves or as directed by your doctor 1

2. Avoid ear trauma:

   • Do not scratch or touch the ear
   • Do not insert anything into the ear canal, including cotton swabs 1

3. If a wick was placed:

   • Do not remove it yourself unless instructed to do so
   • It may fall out on its own, which is a good sign indicating reduced inflammation 1

When to Contact Your Doctor

• If pain or other symptoms don't improve within 48-72 hours
• If symptoms persist beyond 7 days
• If you develop unexpected symptoms or the drops become painful
• If you taste the eardrops (may indicate tympanic membrane perforation) 1

Prevention of Recurrence

• Keep ears dry
• Use ear protection when showering or washing hair
• Avoid cleaning ear canal with cotton-tip applicators 5

Efficacy and Safety

Topical fluoroquinolone eardrops have demonstrated high clinical cure rates (>90%) in clinical trials 6, 7 and are well-tolerated with minimal side effects. The most common adverse events include local pruritus (5%), increased earache (temporary), and application-site reactions (3%) 6.

The once-daily regimen of ofloxacin has shown equivalent efficacy to more frequent dosing schedules, which may improve patient adherence 6, 7.