Can Ciprodex (ciprofloxacin and dexamethasone) be used with Pressure Equalization (PE) tubes?

Using Ciprodex with Pressure Equalization (PE) Tubes

Yes, Ciprodex (ciprofloxacin 0.3%/dexamethasone 0.1%) can and should be used for treating ear infections in patients with pressure equalization (PE) tubes. 1

Benefits of Ciprodex with PE Tubes

• Ciprodex is specifically approved for use in both the middle ear and external auditory canal, making it ideal for patients with PE tubes 2
• The combination of ciprofloxacin (antibiotic) and dexamethasone (steroid) provides dual action against both infection and inflammation 3
• Topical therapy delivers a significantly higher concentration of antibiotics directly to the infection site compared to oral antibiotics, increasing efficacy and decreasing treatment failure 4
• Unlike older ototopical preparations containing potentially ototoxic antibiotics (like aminoglycosides), fluoroquinolone-containing drops like Ciprodex are not ototoxic and are safe to use with PE tubes 4

Clinical Evidence Supporting Use

• Clinical trials have consistently shown Ciprodex to be equal or superior to comparator drugs for treating ear infections with PE tubes 2
• Ciprodex has demonstrated superior efficacy compared to oral antibiotics like amoxicillin/clavulanic acid for acute otitis media with otorrhea through tympanostomy tubes 5
  • Median time to cessation of otorrhea: 4.0 days with Ciprodex vs. 7.0 days with oral antibiotics
  • Clinical cure rates: 85% with Ciprodex vs. 59% with oral antibiotics
• The addition of dexamethasone 0.1% to ciprofloxacin 0.3% has been shown to decrease granulation tissue, improve clinical cure rates, and achieve greater bacterial eradication compared to ciprofloxacin alone 4

Administration Guidelines

• For ear infections with PE tubes and visible drainage:
  • Place Ciprodex drops in the ear canal twice daily for up to 10 days 1
  • "Pump" the flap of skin in front of the ear canal (tragus) a few times after placing the drops to help them enter the ear tube 1
  • Remove any drainage buildup at the opening of the ear canal with a cotton-tipped swab dipped in hydrogen peroxide or warm water 1

Important Considerations

• Ear plugs are generally not necessary for most children with PE tubes during swimming, as water doesn't usually go through the tube 1
• However, ear plugs may be needed in specific situations:
  • If the child experiences pain when water enters the ear canal
  • If discharge is observed coming from the ear canal
  • During swimming more than 6 feet underwater
  • When swimming in non-chlorinated water
  • When dunking the head in soapy bathwater 1
• To avoid yeast infections of the ear canal, don't use antibiotic eardrops frequently or for more than 10 days at a time 1
• Oral antibiotics are generally unnecessary for most ear infections with tubes unless the child is very ill or the infection doesn't respond to ear drops 1

Follow-up Care

• Routine follow-up every 4-6 months is important to ensure the tubes are in place and functioning properly 1
• If drainage occurs after water exposure, it may indicate infection with external auditory canal pathogens like P. aeruginosa or S. aureus, which respond well to topical fluoroquinolone treatment 1