From the Guidelines
Acute otitis externa should be treated with topical antibiotic drops, such as ciprofloxacin 0.3% with dexamethasone 0.1% (Ciprodex) or ofloxacin 0.3% (Floxin Otic), administered as 4 drops into the affected ear twice daily for 7 days, as this is the most effective treatment and reduces the risk of morbidity, mortality, and improves quality of life 1.
Key Considerations
- The ear canal should be gently cleaned of debris if possible before applying drops, and for severe cases with significant swelling, an ear wick may be inserted to facilitate medication delivery 1.
- Oral analgesics like acetaminophen or ibuprofen can help manage pain, and patients should keep the ear dry by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly when showering 1.
- The condition occurs when moisture, trauma, or removal of protective ear wax allows bacteria (commonly Pseudomonas aeruginosa or Staphylococcus aureus) to proliferate in the ear canal, causing inflammation, pain, itching, and sometimes discharge 1.
Special Considerations
- Patients with diabetes, an immunocompromised state, or both require special consideration, as they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1.
- Concurrent middle ear disease can modify treatment of AOE, and patients with a tympanostomy tube or tympanic membrane perforation may develop diffuse AOE because of purulent middle-ear secretions that enter the external ear canal 1.
Treatment Duration and Follow-up
- Eardrops should be used for at least 7 days, even if the patient feels better sooner, to prevent relapse of infection, and if symptoms persist beyond 7 days, the patient should notify their doctor and continue the drops until the symptoms resolve for a maximum of 7 additional days 1.
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 treatment of acute otitis externa with ciprofloxacin otic solution, 0.2% is indicated for susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 2.
- The dosage is the contents of one single-dose container instilled into the affected ear twice daily for 7 days.
- Contraindications include a history of hypersensitivity to ciprofloxacin 2.
- Adverse reactions may include application site pain, ear pruritus, fungal ear superinfection, and headache, each reported in approximately 2-3% of patients 2.
From the Research
Definition and Causes of Acute Otitis Externa
- Acute otitis externa is a common condition involving inflammation of the ear canal, primarily caused by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus being the most common pathogens 3, 4.
- The condition presents with the rapid onset of ear canal inflammation, resulting in otalgia, itching, canal edema, canal erythema, and otorrhea, and often occurs following swimming or minor trauma from inappropriate cleaning 3, 4.
Symptoms and Diagnosis
- Symptoms of acute otitis externa include pain, redness, and swelling of the canal, with tenderness on movement of the pinna or tragus being a classic finding 3, 4, 5.
- Diagnosis is based on clinical signs and symptoms, and may involve bacteriological findings from ear swabs 6.
Treatment Options
- Topical antimicrobials or antibiotics, such as acetic acid, aminoglycosides, polymyxin B, and quinolones, are the treatment of choice in uncomplicated cases, and may be used with or without topical corticosteroids 3, 4, 5.
- Oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 3, 4, 5.
- Ciprofloxacin has been shown to be a useful and effective agent in the local therapy of otitis externa, and may be used in combination with fluocinolone acetonide for improved efficacy and safety 6, 7.
Prevention and Management
- Prevention of acute otitis externa includes avoiding injury to the ear canal and keeping it free of water 4.
- Management of the condition involves assessing pain and recommending analgesic treatment, distinguishing diffuse acute otitis externa from other causes of otalgia, and using topical preparations for initial therapy 5.