From the Guidelines
For ear pain and infection, eardrops alone are the most effective treatment and may contain antibiotics, antiseptics, steroids, or a combination, as stated in the clinical practice guideline: acute otitis externa executive summary 1.
Key Points to Consider
- All eardrops approved for treating acute otitis externa (AOE) are highly effective with no consistent advantage shown for any one specific drug 1.
- The choice of eardrop should be based on factors such as cost, dosing frequency, status of the eardrum, and the doctor’s experience, as well as the patient's opinion and preferences 1.
- It is essential to inform the doctor about any prior ear surgery, opening (hole or perforation) of the eardrum, or ear tube in place, as this may affect the choice of eardrop 1.
- Eardrops should be used for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection, and for a maximum of 7 additional days if symptoms persist 1.
Proper Use of Eardrops
- To use ear drops properly, lie down with the affected ear up, put enough drops in the ear canal to fill it up, and stay in this position for 3 to 5 minutes 1.
- A gentle to-and-fro movement of the ear or pressing with an in/out movement on the small piece of cartilage (tragus) in front of the ear may help the drops penetrate into the ear canal 1.
- Keeping the ear dry is generally a good idea while using ear drops, and one should avoid cleaning the ear themselves as it is tender and could be damaged 1.
Monitoring and Follow-up
- Most people feel better within 48 to 72 hours and have minimal or no symptoms by 7 days, and if pain or other symptoms fail to respond within this timeframe, the doctor should be notified 1.
- Pain medicine is especially important to use for relief in the first few days, until the eardrops begin working, and the doctor can recommend the best pain medicines for each patient 1.
From the FDA Drug Label
Ciprofloxacin and dexamethasone otic suspension is indicated for the treatment of infections caused by susceptible isolates of the designated microorganisms in the specific condition listed below: Acute Otitis Externa (AOE) in pediatric (age 6 months and older), adult and elderly patients due to Staphylococcus aureus and Pseudomonas aeruginosa. The recommended dosage regimen is as follows: Four drops [equivalent to 0. 14 mL of ciprofloxacin and dexamethasone otic suspension, (consisting of 0.42 mg ciprofloxacin and 0. 14 mg dexamethasone)] instilled into the affected ear twice daily for seven days.
Ear Drops for Ear Pain and Infection:
- The ciprofloxacin and dexamethasone otic suspension is used to treat Acute Otitis Externa (AOE), an infection of the outer ear canal.
- The recommended dosage is 4 drops into the affected ear, twice daily for 7 days.
- This medication is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, other quinolones, or any components in the medication, as well as in viral or fungal infections of the external canal 2.
From the Research
Ear Drops for Ear Pain and Infection
- Ear drops are a common treatment for ear pain and infection, particularly for otitis externa, which is an inflammation of the ear canal.
- The choice of ear drops depends on the severity of the infection and the presence of any underlying conditions, such as a perforated eardrum 3.
- Topical antimicrobials or antibiotics, such as ciprofloxacin, neomycin, and polymyxin B, are commonly used to treat otitis externa, often in combination with a corticosteroid to reduce inflammation 4, 5, 3.
Comparison of Ear Drops
- A study comparing ciprofloxacin/dexamethasone with neomycin/polymyxin B/hydrocortisone for otitis externa found that ciprofloxacin/dexamethasone was more effective in reducing ear pain and inflammation 5.
- Another study found that ciprofloxacin/dexamethasone was clinically and microbiologically superior to neomycin/polymyxin B/hydrocortisone in the treatment of otitis externa 4.
- However, a review of the literature found that there is no good evidence that any one antimicrobial or antibiotic preparation is clinically superior to another, and the choice of treatment should be based on individual patient factors 3.
Resistance to Antibiotics
- There is evidence that the pathogens that cause otitis externa, such as Pseudomonas aeruginosa and Staphylococcus aureus, are developing resistance to certain antibiotics, such as neomycin and polymyxin B 6.
- A study found that the minimum inhibitory concentrations (MICs) of neomycin and polymyxin B for P. aeruginosa increased significantly between 1995-1996 and 1999-2000, indicating a decline in susceptibility to these antibiotics 6.
- In contrast, the MICs of ofloxacin, a quinolone antibiotic, remained stable over the same period, suggesting that it may be a more effective treatment option for otitis externa caused by resistant pathogens 6.
Treatment Options
- Topical ciprofloxacin has been shown to be effective in the treatment of otitis externa, with rapid eradication of bacterial pathogens and significant clinical improvement 7.
- The addition of a corticosteroid, such as dexamethasone, may help to reduce inflammation and improve symptoms more quickly 4, 5.
- Oral antibiotics may be reserved for cases where the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 3.