From the Guidelines
Swimmer's ear, or otitis externa, is best treated with antibiotic ear drops containing medications like ciprofloxacin with hydrocortisone (Ciprodex) or neomycin-polymyxin B-hydrocortisone, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. The treatment should be applied as prescribed, typically 3-4 drops in the affected ear 2-3 times daily for 7-10 days.
- Before application, gently clean the outer ear with a washcloth, but never insert anything into the ear canal.
- To apply drops effectively, lie with the affected ear facing up for 3-5 minutes after insertion to ensure the medication reaches the infection.
- Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.
- Keep the ear dry during treatment by avoiding swimming and using earplugs or a shower cap when bathing.
- If symptoms worsen or don't improve after 48-72 hours of treatment, see a doctor. Swimmer's ear occurs when water remains in the ear canal, creating a moist environment where bacteria thrive, leading to inflammation and infection of the ear canal skin.
- Prevention includes drying ears thoroughly after swimming and using alcohol-based ear drops after water exposure. It is essential to note that patients with diabetes, an immunocompromised state, or both require special consideration because they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1.
- Necrotizing (malignant) otitis externa is an aggressive infection that predominantly affects elderly, diabetic, or immunocompromised patients, and its treatment includes surgical debridement and systemic antibiotics adequate to cover pseudomonal and staphylococcal infection.
- Otomycosis, or fungal infection of the external ear canal, is common in tropical countries, humid locations, after long-term topical antibiotic therapy, and in those with diabetes, HIV infection, or an immunocompromised state, and its management may include debridement plus topical antifungal therapy.
From the FDA Drug Label
Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. The contents of one single-dose container (deliverable volume: 0.25 mL) should be instilled into the affected ear twice daily (approximately 12 hours apart) for 7 days.
The treatment for otitis externa (swimmer's ear) infection is ciprofloxacin otic solution, 0.2%. The recommended dosage is:
- Instill 0.25 mL of the solution into the affected ear
- Twice daily (approximately 12 hours apart)
- For 7 days 2
From the Research
Treatment Options for Otitis Externa
The treatment for otitis externa (swimmer's ear) infection typically involves the use of topical antibiotics and corticosteroids.
- Ciprofloxacin 0.3%/dexamethasone 0.1% (CIP/DEX) otic suspension has been shown to be effective in treating otitis externa, with clinical cure rates of 90.9% and microbiologic eradication rates of 94.7% 3.
- CIP/DEX has been compared to neomycin 0.35%/polymyxin B 10,000 IU/mL/hydrocortisone 1.0% (N/P/H) otic suspension, with CIP/DEX demonstrating superior clinical and microbiological efficacy 3, 4.
- CIP/DEX has also been shown to provide rapid relief of pain and reduction of inflammation and edema in patients with acute otitis externa 4.
- Local ciprofloxacin has been compared to a combination of oxytetracycline, polymyxin B, and hydrocortisone, with ciprofloxacin demonstrating effective eradication of bacterial pathogens and marked clinical improvement 5.