What are the instructions for instilling Ciprodex (ciprofloxacin/dexamethasone) for otitis externa?

Instructions for Instilling Ciprodex for Otitis Externa

Have someone else administer the drops whenever possible, as self-administration is difficult and only 40% of patients do it correctly during the first 3 days. 1

Step-by-Step Administration Technique

Preparation

• Wash hands before use 2
• Warm the container by holding it in your hands for at least 1 minute to minimize dizziness from instilling cold solution 2

Positioning and Instillation

• Lie down with the affected ear facing upward 1, 3, 4
• Instill 3-4 drops into the ear canal—enough to fill it completely 1, 4
• The amount needed varies with patient age and size, so run drops along the side of the canal until filled 1

Ensuring Penetration

• Remain in the lying position for 3-5 minutes to allow adequate penetration of the medication 1, 3, 4
• Use a timer to help measure the time, especially helpful for young children 1
• Apply gentle to-and-fro movement of the pinna (outer ear) to eliminate trapped air and ensure filling 1
• Alternative method: Press with an in/out movement on the tragus (the small piece of cartilage in front of the ear) to help distribute drops 1, 3, 4

After Administration

• Sit up and wipe off any excess drops 1
• Leave the ear canal open to dry and avoid trapping moisture 1
• Repeat for the opposite ear if necessary 2

Treatment Duration and Frequency

• Administer drops twice daily (approximately 12 hours apart) for 7 days 2
• Continue for at least 7 days even if symptoms improve sooner to prevent relapse 3, 4
• Most patients experience improvement within 48-72 hours 3, 4

Critical Precautions During Treatment

Keep the Ear Dry

• Cover the ear canal opening with an earplug or cotton with petroleum jelly before showering or hair washing 3, 4
• Consult your doctor about swimming or other water activities during treatment 3, 4

Avoid Ear Manipulation

• Do not clean the ear yourself as it is tender and you could damage the ear canal or eardrum 1, 3, 4
• Do not insert anything into the ear canal, including cotton-tipped swabs 3, 4
• Avoid scratching or touching the ear 3, 4

When Aural Toilet or Wick Placement is Needed

Obstructed Ear Canal

• If drops do not easily run into the ear canal, you may need the ear canal cleaned by your clinician or have a wick placed 1, 3
• The clinician should clear inflammatory debris, obstructing cerumen, or foreign objects before administering drops 1, 3

Wick Management

• A wick may be placed if edema prevents drop entry or if most of the tympanic membrane cannot be visualized 1, 3
• The wick falling out on its own is a good sign indicating the inflammation is clearing 1, 4
• Do not remove the wick yourself unless instructed to do so by your clinician 1, 4
• Once placed, moisten the wick with the first application of drops 1

Common Pitfalls to Avoid

• Self-administration leads to undermedicating in 60% of patients—having an assistant apply drops significantly improves adherence 1
• Missing the ear canal entirely when attempting self-administration 1
• Not maintaining the lying position for the full 3-5 minutes, which prevents adequate drug penetration 1, 4
• Stopping treatment early when symptoms improve, which can lead to relapse 3, 4
• Attempting to clean the ear yourself, risking further trauma to inflamed tissue 1, 3

Warning Signs

• If you taste the eardrops, it may indicate a perforation in the eardrum—inform your doctor 4
• Contact your doctor if drops become painful or you develop unexpected symptoms 4
• If symptoms persist beyond 7 days, notify your doctor and continue drops for a maximum of 7 additional days 3