What are the recommended ear drops for a 23-month-old with otitis externa?

Ear Drops for Otitis Externa in a 23-Month-Old Child

For a 23-month-old child with otitis externa, the recommended treatment is five drops of ofloxacin otic solution 0.3% instilled into the affected ear once daily for seven days. 1

First-Line Treatment Options

• Topical antibiotic therapy is the most effective treatment for otitis externa, with clinical cure rates of 77-96% compared to only 30-67% with systemic antibiotics 2
• For pediatric patients from 6 months to 13 years old, five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days is the recommended dosage 1
• Ofloxacin otic solution administered once daily for 7 days has demonstrated high clinical cure rates of 95% in children with otitis externa 3
• Antibiotic-corticosteroid combinations, such as ciprofloxacin with dexamethasone, are also effective and may provide better symptom relief than antibiotic drops alone 2, 4

Administration Technique

• The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness which may result from instillation of a cold solution 1
• Have the child lie with the affected ear upward, then instill the drops 1
• Maintain this position for 5 minutes to facilitate penetration of the drops into the ear canal 1
• A gentle to-and-fro movement of the ear or pressing with an in/out movement on the tragus can help the drops reach their intended destination 5

Treatment Duration and Expectations

• Standard treatment duration is 7 days for otitis externa, even if symptoms resolve sooner 2
• Most patients experience improvement within 48-72 hours of starting appropriate therapy 2
• If symptoms persist beyond 7 days, notify the doctor and continue drops until symptoms resolve for a maximum of 7 additional days 5

Special Considerations and Precautions

• Cleaning the ear canal of debris before administering drops is recommended for maximum effectiveness 2
• Avoid scratching or touching the ear and do not insert anything into the ear canal, including cotton-tipped swabs 5
• Cover the opening of the ear canal with an earplug or cotton with petroleum jelly prior to showering or hair washing to minimize water entry 5
• If the drops do not easily run into the ear canal, the child may need to have the ear canal cleaned by a clinician or have a wick placed to help in getting the drops into the ear canal 5

Medication Selection Considerations

• Ofloxacin otic solution is particularly safe for use in children as it lacks the ototoxicity associated with neomycin-containing preparations 6
• Ofloxacin has been shown to be as effective as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension in treating otitis externa in children, with comparable cure rates (93.8% vs. 94.7%) 7
• Once-daily dosing of ofloxacin offers better adherence compared to preparations requiring multiple daily doses 6

Common Pitfalls to Avoid

• Stopping treatment too early once symptoms improve can lead to treatment failure 2
• Using cotton-tipped swabs to clean deep in the ear canal can push debris further in and is not recommended 8
• Prolonged use of topical therapy beyond recommended duration may result in overgrowth of non-susceptible bacteria and fungi 4

When to Consider Systemic Antibiotics

• Systemic antibiotics should be considered only when infection spreads beyond the ear canal 2
• Immunocompromised patients or those with cellulitis of adjacent skin may require systemic antibiotics 2
• Symptoms persisting despite appropriate topical therapy may necessitate systemic antibiotics 2