What is the recommended dosage of CIPRODEX (ciprofloxacin and dexamethasone) eardrops for treating outer ear infections?

CIPRODEX Eardrops Dosage for Acute Otitis Externa

For acute otitis externa in patients 6 months and older, instill 4 drops of CIPRODEX (ciprofloxacin 0.3%/dexamethasone 0.1%) into the affected ear twice daily for 7 days. 1

Exact Dosing Instructions

• Four drops (equivalent to 0.14 mL, containing 0.42 mg ciprofloxacin and 0.14 mg dexamethasone) per affected ear 1
• Twice daily for 7 days 1
• Minimum age: 6 months 1

Critical Administration Steps

Before applying drops:

• Shake the bottle well immediately before each use 1
• Warm the bottle by holding it in your hand for 1-2 minutes to prevent dizziness from cold suspension 1
• Clean the ear canal of debris, cerumen, or inflammatory material if obstructed—this is essential for medication to reach infected tissue 2, 3

During application:

• Have someone else administer the drops when possible—only 40% of patients self-administer correctly during the first 3 days 2, 3
• Lie with the affected ear facing upward 1
• Instill the drops into the ear canal 1
• Maintain this position for 60 seconds (FDA label) or 3-5 minutes (clinical guidelines recommend longer for optimal penetration) 1, 2, 3
• Apply gentle to-and-fro movement of the pinna or press the tragus in/out (tragal pumping) to eliminate trapped air 2, 3

After application:

• Leave the canal open to dry—avoid trapping moisture 2, 3
• Discard unused portion after completing therapy 1

When CIPRODEX Is Specifically Indicated

CIPRODEX is the preferred choice when:

• Tympanic membrane integrity is uncertain or compromised—it is non-ototoxic unlike aminoglycoside-containing drops 3
• Patient has tympanostomy tubes in place 2, 3
• Patient has perforated tympanic membrane 3

Clinical Efficacy

• CIPRODEX achieves 90.9% clinical cure rates at test-of-cure, superior to neomycin/polymyxin B/hydrocortisone (83.9%) 4
• Microbiologic eradication rate of 94.7% versus 86.0% with neomycin combinations 4
• The addition of dexamethasone to ciprofloxacin hastens pain relief and reduces inflammation more effectively than antibiotic alone 3, 4, 5

Expected Timeline and Follow-Up

• Pain typically improves within 48-72 hours of starting treatment 3
• Clinical resolution occurs within 7-10 days in 65-90% of patients 3
• Reassess if no improvement within 48-72 hours—consider inadequate drug delivery, poor adherence, fungal co-infection, allergic contact dermatitis, or incorrect diagnosis 3
• If symptoms persist beyond 7 days, continue drops until resolution for maximum of 7 additional days (14 days total maximum) 3, 6

Pain Management

• Prescribe appropriate analgesics (acetaminophen or NSAIDs) based on pain severity, especially during the first 48-72 hours 3
• Do NOT use topical anesthetic drops (benzocaine)—they are not FDA-approved for active ear infections and can mask delayed treatment response 3

Essential Patient Instructions

Keep the ear dry during treatment:

• Cover ear canal opening with petroleum jelly-coated cotton or earplug before showering 3
• Avoid swimming until treatment is complete 3
• Do not insert cotton swabs or other objects into the ear canal 3

Warning signs requiring immediate contact:

• If you taste the eardrops—this indicates tympanic membrane perforation 3
• If symptoms worsen or fail to improve within 48-72 hours 3
• If ear drainage continues beyond 7 days 2, 3

Special Populations Requiring Modified Management

Diabetic or immunocompromised patients:

• Monitor more carefully for necrotizing otitis externa 3
• Consider adding systemic fluoroquinolone antibiotics even for uncomplicated cases 3
• Use atraumatic suctioning under microscopic guidance instead of irrigation—aggressive irrigation can trigger necrotizing otitis externa 3

If ear canal is severely edematous:

• Place a compressed cellulose wick to facilitate drug delivery—it expands when exposed to moisture and may fall out on its own as inflammation resolves 2, 3

Common Pitfalls to Avoid

• Failing to clean debris before drop administration—medication cannot reach infected tissue if canal is obstructed 2, 3
• Using aminoglycoside-containing drops when tympanic membrane integrity is unknown—these are ototoxic 3
• Prescribing oral antibiotics for uncomplicated acute otitis externa—topical therapy is superior with 77-96% cure rates versus 30-67% for oral antibiotics 3
• Inadequate treatment duration—complete the full 7-day course even if symptoms resolve earlier to prevent relapse 3, 6
• Missing fungal co-infection—consider if treatment fails, especially in diabetic patients 3

Contraindications

• Hypersensitivity to ciprofloxacin, other quinolones, or any component 1
• Viral infections of the external canal (including herpes simplex) 1
• Fungal otic infections 1