What is the dosage and treatment regimen for Ciprodex (ciprofloxacin and dexamethasone) eardrops for ear infections?

Ciprodex (Ciprofloxacin/Dexamethasone) Otic Suspension Dosing and Administration

Standard Dosage Regimen

For acute otitis externa in patients 6 months and older, instill 4 drops into the affected ear twice daily for 7 days. 1

• Each 4-drop dose delivers 0.14 mL of suspension containing 0.42 mg ciprofloxacin and 0.14 mg dexamethasone 1
• The medication is FDA-approved for otic use only—never for ophthalmic use or injection 1
• Shake the bottle well immediately before each use 1

Proper Administration Technique

Warm the bottle by holding it in your hand for 1-2 minutes before instillation to prevent dizziness from cold suspension. 1

Step-by-Step Instructions:

• Have the patient lie down with the affected ear facing upward 1, 2
• Instill the drops along the side of the ear canal until filled 2
• Maintain this position for 60 seconds (FDA label) or 3-5 minutes (AAO-HNS guidelines) to facilitate penetration 1, 2
• Perform tragal pumping: press the tragus (small cartilage flap in front of the ear) with gentle in-and-out movements several times after instillation 2
• Wipe away excess drops after rising 2
• Repeat for the opposite ear if needed 1

Having someone else administer the drops significantly improves adherence and proper delivery—only 40% of patients self-administer correctly during the first 3 days. 2

Clinical Context and Indications

Ciprodex is indicated specifically for acute otitis externa caused by Staphylococcus aureus and Pseudomonas aeruginosa. 1

• Also highly effective for acute otitis media with tympanostomy tubes (acute TTO), where it is superior to oral antibiotics 2, 3
• The 0.3% ciprofloxacin concentration (3000 mcg/mL) vastly exceeds the MIC of virtually all relevant pathogens 4
• Ciprodex is the only FDA-approved fluoroquinolone/steroid otic drop safe for use in both the external canal and middle ear 4, 5

Enhanced Delivery for Obstructed Canals

If the ear canal is obstructed by debris, edema, or discharge, perform aural toilet before administering drops to ensure medication reaches the infection site. 2

• Clean visible debris by blotting with cotton or gently suctioning with an infant nasal aspirator 2
• Remove dry crust with a cotton-tipped swab dipped in hydrogen peroxide or warm water 2
• If the canal remains severely edematous and obstructed, placement of a wick by the clinician may be necessary to facilitate drug delivery 2
• The wick may fall out spontaneously as inflammation resolves—this is a positive sign 2

Treatment Duration and Monitoring

Complete the full 7-day course even if symptoms improve earlier to prevent relapse. 1

• Discard any unused portion after completing therapy 1
• Patients should notify their physician if pain or symptoms fail to improve within 48-72 hours 6
• For acute TTO, clinical cure rates with topical therapy range from 77-96% versus only 30-67% with oral antibiotics 2
• Median time to cessation of otorrhea with Ciprodex is 4 days versus 7 days with oral amoxicillin/clavulanate 3

Comparative Efficacy

Ciprodex demonstrates superior clinical and microbiological outcomes compared to neomycin/polymyxin B/hydrocortisone (Cortisporin). 7, 8

• Clinical cure rates: 90.9% with Ciprodex versus 83.9% with Cortisporin at test-of-cure 7
• Microbiologic eradication: 94.7% versus 86.0% 7
• Pain relief occurs more rapidly with Ciprodex, with severe pain decreasing within the first 12 hours 8
• Ciprodex requires only twice-daily dosing versus three times daily for Cortisporin, improving adherence 7

Safety Considerations and Precautions

Keep the ear dry during treatment—avoid swimming, head dunking, and water entry into the ear canal. 2

• Cover the ear with cotton saturated with Vaseline during bathing or hair washing 2
• Do not use Ciprodex if there is a known hypersensitivity to quinolones or any component 1
• Contraindicated in viral infections (including herpes simplex) and fungal otic infections 1
• Limit treatment to a single 7-day course; prolonged or frequent use may induce fungal external otitis (otomycosis) 2, 5

Common Adverse Events:

• Ear discomfort (3%), ear pain (2.3%), ear pruritus (1.5%) 1
• Significantly fewer systemic side effects compared to oral antibiotics—no diarrhea (19.5% with oral amoxicillin/clavulanate), dermatitis, or GI upset 3

Critical Safety Advantage

Unlike aminoglycoside-containing drops (e.g., neomycin), Ciprodex is non-ototoxic and safe for use when tympanic membrane perforation or tympanostomy tubes are present. 2, 4, 5

• Aminoglycoside drops used for otitis externa can cause permanent hearing damage if they reach the middle ear 2
• Topical quinolones have no significant systemic absorption, making them safe in children despite systemic quinolone restrictions 2

When Systemic Antibiotics Are Needed

Reserve oral antibiotics for specific circumstances, not routine acute otitis externa or uncomplicated acute TTO. 2

Systemic therapy is appropriate when:

• Cellulitis of the pinna or adjacent skin is present 2
• Concurrent bacterial infection exists (sinusitis, pneumonia, streptococcal pharyngitis) 2
• Signs of severe infection appear (high fever, severe otalgia, toxic appearance) 2
• Acute TTO persists or worsens despite topical therapy 2