What is the recommended dosage and treatment protocol for ofloxacin (fluorquinolone antibiotic) drops in patients with ear infections and a perforated tympanic membrane?

Ofloxacin Drops for Ear Infections with Perforated Tympanic Membrane

For patients with ear infections and perforated tympanic membranes, ofloxacin 0.3% otic solution should be administered as 10 drops (0.5 mL) instilled into the affected ear twice daily for fourteen days. 1

Dosage Protocol for Different Patient Groups

• Adults and children ≥12 years with chronic suppurative otitis media and perforated tympanic membranes:

  • 10 drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 1

• Children 1-12 years with acute otitis media and tympanostomy tubes:

  • 5 drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear twice daily for ten days 1

• Children 6 months to 13 years with otitis externa:

  • 5 drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days 1

Administration Technique

1. Preparation: Warm the solution by holding the bottle in hand for 1-2 minutes to prevent dizziness from cold solution 1

2. Patient positioning: Patient should lie with affected ear upward 1

3. For perforated tympanic membranes: After instilling drops, pump the tragus 4 times by pushing inward to facilitate penetration into the middle ear 1

4. Duration: Maintain position for five minutes to allow proper penetration 1

5. Repeat if necessary for the opposite ear 1

Rationale for Ofloxacin in Perforated Tympanic Membranes

• Non-ototoxic properties: When a patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube, clinicians should prescribe a non-ototoxic topical preparation 2

• Safety profile: Unlike some other ototopical antibiotics, ofloxacin has not been associated with ototoxicity in clinical studies in humans 3

• Efficacy: Ofloxacin otic solution has demonstrated high clinical cure rates (91%) in patients with chronic suppurative otitis media and perforated tympanic membranes 4

• Broad spectrum coverage: Topical administration produces very high concentrations in the ear, effectively covering most common ear pathogens including Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis 3, 4

Special Considerations

• Wick placement: If the ear canal is edematous or obstructed, consider placing a wick to enhance medication delivery 2

  • Use compressed cellulose wick (not simple cotton ball) 2
  • Wick may be moistened with aqueous solution before first application of drops 2
  • Remove wick once ear canal edema subsides (typically within 24-72 hours) 2

• Aural toilet: Perform gentle cleaning of the ear canal to remove debris that may impede drug delivery 2

  • For patients with perforated tympanic membranes, atraumatic cleaning with aural suctioning under microscopic guidance may be necessary 2

• Monitoring: Reassess patients who fail to respond to initial therapy within 48-72 hours 2

Potential Adverse Effects

• Most common side effects are mild to moderate, with most frequent being:
  • Bitter taste (5%), primarily in patients with non-intact tympanic membranes 3
  • Pruritus (2%) 3

Healing Benefits

• Recent evidence shows ofloxacin otic solution can enhance healing of traumatic tympanic membrane perforations:
  • Increased closure rate (RR 1.18) compared to spontaneous healing 5
  • Significantly reduced healing time (mean difference -18.4 days) 5
  • No evidence of increased risk of hearing loss when used in traumatic perforations 5

Cautions

• Avoid prolonged or repetitive administration of topical drops in patients with perforated tympanic membranes, as severe hearing loss has been observed in such cases 2

• Limit therapy to a single course of the recommended duration to minimize risks 2