What is the best antibiotic for a child with tympanostomy (ear) tubes who has developed an ear infection?

Best Antibiotic Treatment for Children with Tympanostomy Tubes and Ear Infections

For children with tympanostomy tubes who develop an ear infection, topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) are the best treatment option, providing superior clinical cure rates compared to oral antibiotics. 1

Treatment Algorithm Based on Presentation

For Ear Infections with Visible Drainage:

• Topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) should be administered twice daily for up to 10 days 1, 2
• Clinical cure rates with topical therapy range from 77% to 96%, compared to only 30% to 67% with systemic oral antibiotics 1
• The visible drainage indicates the tube is working properly to drain infection from the middle ear space 1
• Most children will not have pain or fever when the tube is functioning properly 1

Application Technique:

• Place drops in the ear canal twice daily 1
• "Pump" the flap of skin in front of the ear canal (tragus) after placing the drops to help them enter the ear tube 1, 2
• Clean the ear canal before administering drops by removing drainage with a cotton-tipped swab dipped in hydrogen peroxide or warm water 1

For Ear Infections without Visible Drainage:

• First determine if the tube is open (functioning) 1
• If the tube is open, the infection should resolve without antibiotics 1
• If the tube is blocked, treat the infection as if the tube was not there 1

Why Topical Therapy is Superior

• Topical therapy delivers higher drug concentration directly at the infection site 1, 2
• Topical therapy provides better coverage of likely pathogens, including Pseudomonas aeruginosa and Staphylococcus aureus 1, 2
• Topical therapy avoids adverse events associated with systemic antibiotics, including:
  • Dermatitis and allergic reactions 1
  • Gastrointestinal upset 1
  • Oral thrush 1
  • Increased antibiotic resistance 1

Important Considerations

• Only use topical drops approved for use with tympanostomy tubes (quinolone drops with or without steroid) to avoid potential ototoxicity from aminoglycoside-containing eardrops 1
• Limit topical therapy to a single course of no more than 10 days to avoid yeast infections 1
• Protect the ear canal from water entry during treatment by using cotton saturated with Vaseline during bathing 1
• Do not allow swimming until drainage stops 1

When to Consider Oral Antibiotics

• When the child appears very ill 1
• When the child has another reason to be on an antibiotic 1
• When the infection does not resolve after using ear drops 1

When to Seek Specialist Care

• If ear drainage continues for more than 7 days despite treatment 1, 2
• If ear infections occur frequently 1, 2
• If the child has hearing loss, continued ear pain, or discomfort 1, 2
• If there is excessive wax build-up in the ear canal 1, 2

Common Pathogens in Ear Infections with Tympanostomy Tubes

• Pseudomonas aeruginosa and Staphylococcus aureus are common after water exposure or in older children 1
• Typical nasopharyngeal pathogens in younger children include Streptococcus pneumoniae, Haemophilus influenzae (nontypeable), and Moraxella catarrhalis 1
• Methicillin-resistant Staphylococcus aureus (MRSA) should be suspected when otorrhea is recurrent or recalcitrant 1