What is the recommended dosage and administration technique for ofloxacin (a fluoroquinolone antibiotic) ear drops in treating ear infections?

Ofloxacin Ear Drop Administration: Correcting Your Technique

Your current dosing instructions are incorrect and potentially harmful—you should NOT be using 6 drops per ear or covering the ear canal with cotton after administration. 1

Correct Dosing by Age and Indication

For Otitis Externa (Swimmer's Ear)

• Children 6 months to <13 years: 5 drops once daily for 7 days 1
• Adolescents/adults ≥13 years: 10 drops once daily for 7 days 1

For Acute Otitis Media with Tympanostomy Tubes

• Children 1-12 years: 5 drops twice daily for 10 days 1

For Chronic Suppurative Otitis Media with Perforated Tympanic Membrane

• Patients ≥12 years: 10 drops twice daily for 14 days 1

Proper Administration Technique

The critical steps you're missing:

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

2. Have someone else administer the drops if possible, as self-administration leads to only 40% proper technique 2

3. Patient positioning: Lie with affected ear facing upward 2, 1

4. Instill drops along the side of the ear canal until filled (amount varies by age as above) 2

5. For middle ear infections (perforated membrane or tubes): Pump the tragus (the small cartilage flap in front of the ear canal) 4 times with an in/out motion to facilitate penetration into the middle ear 1, 2

6. For ear canal infections: Gently pull the outer ear upward and backward, OR use gentle to-and-fro movement of the pinna 2, 1

7. Maintain position for 5 minutes—use a timer, as this is essential for adequate drug penetration 2, 1

8. After 5 minutes: Sit up and wipe off excess drops 2

Critical Error: Do NOT Cover with Cotton

Leaving the ear canal open is essential 2. After placing drops, the canal should be left open to dry and avoid trapping moisture and infected debris 2. Cotton should only be used:

• Before showering/hair washing (petroleum jelly-coated cotton to prevent water entry) 2
• To absorb drainage at the ear canal opening (not inserted into the canal) 2

Common Pitfalls to Avoid

• Stopping treatment early: Continue for the full 7 days even if symptoms improve within 48-72 hours, to prevent relapse 2, 3
• Underdosing: Using 6 drops instead of the correct 5 or 10 drops based on age may lead to treatment failure 1
• Skipping the 5-minute wait: Only 40% of patients maintain position adequately, leading to poor drug delivery 2
• Not pumping the tragus when treating middle ear infections with perforated membranes or tubes 1
• Inserting cotton into the canal: This traps moisture and debris, worsening infection 2

Patient Instructions for Keeping Ear Dry

• Cover ear canal opening with petroleum jelly-coated cotton or earplug before showering 2
• Avoid swimming during treatment 2
• Do not insert cotton swabs or any objects into the ear canal 2

When to Reassess

Contact the patient or have them return if:

• No improvement within 48-72 hours 3
• Drainage persists beyond 7 days 2
• Pain worsens or new symptoms develop 2
• Patient tastes the drops (indicates tympanic membrane perforation—ensure you're using the appropriate fluoroquinolone formulation) 2, 4