What is the recommended dose of Ciprodex (ciprofloxacin and dexamethasone) ear drops for a patient with acute otitis externa or otitis media?

Ciprodex Dosing 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

• Each dose consists of 4 drops (equivalent to 0.14 mL, containing 0.42 mg ciprofloxacin and 0.14 mg dexamethasone) instilled into the affected ear twice daily 1
• Treatment duration is 7 days minimum, even if symptoms resolve earlier, to prevent relapse 2, 1
• The suspension must be shaken well immediately before each use 1

Proper Administration Technique

• Warm the bottle in your hand for 1-2 minutes before instillation to avoid dizziness from cold suspension 1
• Have someone else administer the drops if possible, as only 40% of patients self-administer correctly 2
• Lie with the affected ear facing upward 2, 1
• Instill 4 drops to fill the ear canal completely 2, 1
• Maintain this position for 60 seconds (per FDA label) or 3-5 minutes (per clinical guidelines) to facilitate penetration 2, 1
• Apply gentle to-and-fro movement of the pinna or press the tragus with in/out motion to eliminate trapped air 2
• Wipe off excess drops after sitting up 2

Critical Precautions

• Ciprodex is contraindicated in patients with viral infections (including herpes simplex) or fungal otic infections 1
• Discontinue immediately if skin rash or hypersensitivity reaction occurs 1
• Keep the ear dry during treatment—cover with petroleum jelly-coated cotton or earplug before showering 2
• Do not insert anything into the ear canal, including cotton swabs 2
• If you taste the drops, inform your doctor immediately as this indicates tympanic membrane perforation 2

Expected Clinical Course

• Pain typically improves within 48-72 hours of starting treatment 3, 2
• Most patients have minimal or no symptoms by 7 days 2
• Clinical cure rates with Ciprodex are 85-90% at test-of-cure visit 4, 5
• Ciprodex provides faster pain relief than neomycin/polymyxin/hydrocortisone, with severe pain decreasing within the first 12 hours 6

When to Reassess

• Return if no improvement occurs within 48-72 hours 3
• Contact your doctor if pain worsens, new symptoms develop, or local rash/severe irritation occurs 7
• If otorrhea persists after completing the full 7-day course, further evaluation is needed to exclude underlying conditions 1

Pain Management

• Oral analgesics (acetaminophen or NSAIDs) may be needed during the first 48-72 hours until the drops begin working 3, 2
• Topical anesthetic drops are not recommended as they can mask delayed treatment response 2

Common Pitfalls to Avoid

• Stopping treatment when symptoms improve before completing the full 7-day course 2
• Failing to warm the bottle before administration 1
• Not maintaining the upward position long enough for adequate penetration 1
• Using Ciprodex when fungal infection is suspected—this requires antifungal therapy instead 3, 1