What is the recommended dosage of neomycin-polymyxin-hydrocortisone (neomycin-polymyxin-hydrocortisone) 3.5 mg-10,000 unit/mL-1% ear drops for the treatment of otitis externa?

Dosage of Neomycin-Polymyxin-Hydrocortisone Ear Drops for Otitis Externa

For otitis externa, neomycin-polymyxin-hydrocortisone 3.5 mg-10,000 unit/mL-1% ear drops should be administered as four drops in the affected ear 3-4 times daily for adults, or three drops 3-4 times daily for children, for a maximum of 10 consecutive days. 1

Proper Administration Technique

• Have the patient lie with the affected ear upward
• Instill the prescribed number of drops into the ear canal
• Maintain this position for 5 minutes to facilitate penetration
• Repeat for the opposite ear if necessary
• Alternative method: Insert a cotton wick into the canal, saturate with solution, and replace every 24 hours (keeping it moist by adding solution every 4 hours) 1

Important Considerations and Cautions

Safety Concerns

• Neomycin-containing drops should be avoided if tympanic membrane perforation is suspected due to potential ototoxicity 2
• Neomycin carries a high risk of contact sensitivity 2
• Evidence suggests declining susceptibility of common pathogens to neomycin and polymyxin B over time 3

Treatment Duration

• Therapy should be limited to 10 consecutive days 1
• The American Academy of Otolaryngology-Head and Neck Surgery recommends treating otitis externa for at least 7 days, even if symptoms improve sooner 2

Ear Care During Treatment

• Keep the ear dry during treatment
• Cover the ear canal with an earplug or cotton with petroleum jelly before showering
• Avoid inserting anything into the ear canal, including cotton-tipped swabs 2

Alternative Treatment Options

Fluoroquinolone-containing ear drops are preferred over neomycin-containing products due to:

• Better safety profile (non-ototoxic)
• No risk of contact sensitivity
• Maintained antimicrobial efficacy 2, 3

Specific alternatives include:

• Ofloxacin otic solution (once daily dosing has shown equivalent efficacy to neomycin-polymyxin-hydrocortisone four times daily) 4
• Ciprofloxacin/dexamethasone (twice daily dosing has demonstrated superior clinical and microbiological outcomes compared to neomycin-polymyxin-hydrocortisone) 5

Clinical Efficacy

• Clinical studies show that while neomycin-polymyxin-hydrocortisone is effective for otitis externa, fluoroquinolone preparations may offer advantages:
  • Similar or better efficacy
  • More convenient dosing schedules
  • Lower risk of adverse effects 4, 5
• A study comparing boric acid with neomycin-polymyxin-hydrocortisone showed similar pain relief, though the neomycin combination had slightly higher rates of itching and ear canal swelling 6

When to Consider Alternative Therapy

• If symptoms persist beyond 7 days despite treatment
• For patients with known or suspected tympanic membrane perforation
• For patients with history of contact sensitivity to neomycin
• If there are signs of severe infection or spreading cellulitis 2