How should I manage suspected ear infection with impacted wax, currently treated with Ciplox (Ciprofloxacin) ear drops, Dolo 650 (Paracetamol 650mg), and Levocetirizine 5mg?

Management of Ear Infection with Impacted Wax

For suspected ear infection with impacted earwax, you should first have the wax professionally removed by a clinician with appropriate equipment and training before continuing treatment with antibiotic ear drops, as impacted wax prevents effective delivery of medication to the infected area. 1

Assessment and Initial Management

• Cerumen impaction must be addressed first, as it prevents proper assessment of the ear canal and tympanic membrane, and blocks effective delivery of topical medications 1
• Professional removal of impacted wax is recommended rather than self-treatment when infection is suspected, as improper techniques can worsen the condition 1
• Manual removal by a trained clinician using appropriate instrumentation is preferred when infection is present, as irrigation may spread infection 1

Current Treatment Evaluation

• Ciprofloxacin (Ciplox) ear drops are appropriate for treating bacterial ear infections, particularly those caused by Pseudomonas aeruginosa, but cannot work effectively if blocked by wax 2
• Paracetamol (Dolo 650) is appropriate for pain management during the first few days until antibiotic therapy begins working 1
• Levocetirizine may help with associated allergic symptoms but is not a primary treatment for ear infections 1

Proper Medication Administration After Wax Removal

• After professional wax removal, continue Ciprofloxacin ear drops twice daily (12 hours apart) for at least 7 days, even if symptoms improve sooner 1, 2
• Proper administration technique is crucial for effectiveness:
  • Wash hands before use
  • Warm the drops in your hands for one minute before instillation
  • Lie with the affected ear upward
  • Instill the prescribed number of drops
  • Maintain position for at least one minute to facilitate penetration
  • Gently pump the flap of skin in front of the ear canal (tragus) to help drops enter the ear canal 1, 2

Contraindicated Practices

• Do not attempt to remove impacted wax yourself using cotton swabs, as this can push wax deeper and cause injury 1
• Avoid ear candling/coning, which has no proven benefit and can cause serious harm including burns, obstruction, and tympanic membrane perforation 1
• Do not irrigate the ear if you suspect a perforated eardrum or have had previous ear surgery 1

When to Seek Further Medical Care

• If symptoms persist beyond 7 days despite treatment 1
• If you experience increased pain, fever, dizziness, or hearing loss during treatment 1
• If drainage from the ear continues or worsens 1
• If you taste the ear drops, which may indicate a perforated eardrum 1, 2

Prevention of Future Episodes

• Avoid inserting anything into the ear canal, including cotton-tipped swabs 1
• Cover the ear opening with an earplug or cotton with petroleum jelly during showering or hair washing 1
• Regular follow-up with a healthcare provider for ear examinations, especially if you are prone to wax buildup 1