From the Guidelines
The most effective combination ear drops for treating conditions like acute otitis externa or otitis media with perforated eardrums are those containing both steroids and antibiotics, such as Ciprodex (ciprofloxacin and dexamethasone) or Cipro HC (ciprofloxacin and hydrocortisone), as they simultaneously address both the infectious and inflammatory components of ear conditions, with superior outcomes compared to oral antibiotics or initial observation, as shown in studies 1. When considering treatment options, it's essential to prioritize the use of topical antibiotic therapy, which has been shown to be more effective than systemic oral antibiotics in resolving otorrhea and is also more cost-effective 1. The choice of topical antibiotic drops should be guided by the likelihood of the causative pathogens, with quinolone drops being effective against common pathogens such as Pseudomonas aeruginosa and Streptococcus pneumoniae 1. Some key points to consider when using combination ear drops include:
- Standard dosing usually involves 3-4 drops in the affected ear twice daily for 7-10 days, though this varies by product and condition 1.
- These medications should only be used with an intact eardrum unless specifically prescribed otherwise, to avoid potential ototoxicity from aminoglycoside-containing eardrops 1.
- Side effects may include local irritation, and prolonged use should be avoided as it can lead to fungal overgrowth or antibiotic resistance 1.
- Caregivers should be advised to limit topical therapy to a single course of no more than 10 days, and to clean the ear canal of any debris or discharge before administering the drops 1. The most recent and highest quality study 1 supports the use of topical quinolone otic drops, such as Ciprodex or Cipro HC, as the first-line treatment for acute otitis externa or otitis media with perforated eardrums, due to their effectiveness in resolving otorrhea and reducing symptoms, as well as their safety profile and low risk of adverse events.
From the FDA Drug Label
Ciprofloxacin and Dexamethasone Otic Suspension, USP contains the quinolone antimicrobial, ciprofloxacin hydrochloride, USP, combined with the corticosteroid, dexamethasone USP, in a sterile, preserved suspension for otic use
- Combination ear steroids and antibiotics:
- Key components:
- Ciprofloxacin (antibiotic)
- Dexamethasone (steroid)
From the Research
Combo Ear Steroids and Antibiotics
- Ciprofloxacin 0.3%/dexamethasone 0.1% (CIP/DEX) otic suspension 3, 4, 5
- Neomycin 0.35%/polymyxin B 10,000 IU/mL/hydrocortisone 1.0% (N/P/H) otic suspension 3, 4, 5
- Polymyxin B/neomycin/hydrocortisone (PNH) otic suspension 5, 6, 7
- Ciprofloxacin otic solution 0.2% 7
Comparison of Efficacy and Safety
- CIP/DEX was found to be clinically and microbiologically superior to N/P/H in the treatment of mild to severe acute otitis externa 3
- CIP/DEX provided greater pain relief and a rapid reduction in severe pain compared to NPH 4
- CD (ciprofloxacin 0.3%/dexamethasone 0.1%) had a significantly less time to cure compared to PNH (polymyxin B/neomycin/hydrocortisone) 5
- Ciprofloxacin otic solution 0.2% was found to be noninferior to PNH in the treatment of acute diffuse otitis externa 7