What are the best inexpensive ear drops for treating otitis externa (inflammation of the outer ear)?

From the Guidelines

For otitis externa (swimmer's ear), the best inexpensive treatment option is over-the-counter 2% acetic acid solutions such as Swim-Ear or VoSol, which typically cost $5-15. These acidic drops create an environment hostile to bacteria and fungi that cause the infection 1. The key components of managing diffuse AOE include identifying patients with other disease processes that could seriously affect the outcome of AOE, such as diabetes, HIV infection, or other immunocompromised states 2. Apply 3-5 drops into the affected ear canal 3-4 times daily for 7-10 days, as most people feel better within 48 to 72 hours and have minimal or no symptoms by 7 days 3. Before application, gently clean the outer ear with a washcloth, but avoid inserting anything into the ear canal. For more severe cases, prescription combination drops containing an antibiotic (like neomycin or ciprofloxacin) and a steroid (like hydrocortisone) are more effective but costlier 4. Some important considerations when treating AOE include:

• Avoid scratching or touching the ear and do not insert anything into the ear canal, including cotton-tipped swabs 3
• Cover the opening of ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry 3
• Check with your doctor regarding swimming or other water activities that may take place during, or soon after, your infection 3
• Eardrops are, in general, very safe and well tolerated, but some people report local rash, itching, irritation, or discomfort 3 Prevention is also important - keep ears dry after swimming by tilting your head to each side or using a hair dryer on low setting, and consider using preventive drops (1:1 mixture of white vinegar and rubbing alcohol) after water exposure. If symptoms worsen or include fever, severe pain, or drainage, seek medical attention as oral antibiotics may be necessary.

From the FDA Drug Label

Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. The best inexpensive ear drops for treating otitis externa are not explicitly stated in the provided drug label. However, ciprofloxacin otic solution, 0.2% is indicated for the treatment of acute otitis externa due to susceptible isolates of certain bacteria.

• The drug label does not provide information on the cost or comparison of prices with other ear drops.
• Ciprofloxacin otic solution, 0.2% may be considered as an option for treating otitis externa, but its cost and affordability should be evaluated separately 5.

From the Research

Inexpensive Ear Drops for Otitis Externa

• The following ear drops have been studied for their efficacy in treating otitis externa: + Ciprofloxacin/dexamethasone otic suspension 6 + Ofloxacin otic solution 7 + Neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension 7, 6 + Acetic acid ear drops 8
• A study comparing ciprofloxacin/dexamethasone otic suspension with neomycin/polymyxin B/hydrocortisone otic suspension found that the ciprofloxacin/dexamethasone suspension was clinically and microbiologically superior 6
• Another study found that ofloxacin otic solution was as effective and safe as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension in treating otitis externa in children 7
• A systematic review of interventions for acute otitis externa found that topical antimicrobials containing steroids were significantly more effective than placebo drops, but that there were no clinically meaningful differences between the various topical interventions reviewed 8

Comparison of Ear Drops

• A study comparing Auricularum otic powder with Dex-Otic ear drops found that the otic powder promoted earlier healing and pain relief 9
• A study comparing ciprofloxacin ear drops with oxytetracycline/polymyxin B/hydrocortisone ear drops found that the ciprofloxacin ear drops were more effective in eradicating bacterial pathogens 10
• The systematic review found that acetic acid ear drops were less effective than antibiotic/steroid ear drops in terms of cure rate at two and three weeks 8

Cost and Availability

• The cost and availability of these ear drops may vary depending on the location and insurance coverage
• It is essential to consult with a healthcare professional to determine the best course of treatment for otitis externa, as they can recommend the most effective and affordable option 8