From the Guidelines
For otitis media with a levofloxacin allergy, neomycin/polymyxin B/hydrocortisone drops (3-4 drops 3-4 times daily for 7-10 days) may be a safer option due to potential cross-reactivity with other fluoroquinolones like ciprofloxacin and ofloxacin. According to the most recent guideline 1, topical antibiotic therapy is preferred for treating acute tympanostomy tube otorrhea (TTO) in children, with quinolone drops being a suitable option. However, given the levofloxacin allergy, caution is necessary when considering other fluoroquinolones.
The guideline 1 highlights the importance of using only topical drops approved for use with tympanostomy tubes to avoid potential ototoxicity from aminoglycoside-containing eardrops. Neomycin/polymyxin B/hydrocortisone drops are a viable alternative, but it is essential to be aware of the potential for contact sensitivity, as noted in the guideline 1.
Before using any ear drops, the ear canal should be gently cleaned, and drops should be warmed to room temperature and administered with the head tilted to allow the medication to penetrate the ear canal 1. A healthcare provider should evaluate the specific type of otitis media and severity of the fluoroquinolone allergy to determine the safest and most effective treatment option.
Key considerations include:
- Gently cleaning the ear canal before administering drops
- Warming the drops to room temperature
- Administering the drops with the head tilted
- Limiting topical therapy to a single course of no more than 10 days
- Being aware of potential side effects, such as local rash, itching, or discomfort 1
Ultimately, the choice of ear drops should be made in consultation with a healthcare provider, taking into account the individual's specific condition and medical history 1.
From the Research
Otitis Media Treatment Options with Levofloxacin Allergy
Given the allergy to levofloxacin, alternative ear drop options for otitis media need to be considered.
- Ofloxacin Otic Solution: Studies have shown that ofloxacin otic solution is effective in treating otitis externa and chronic suppurative otitis media 2, 3. It has been compared to neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension and found to have equivalent cure rates in some cases.
- Ciprofloxacin/Dexamethasone: This combination has been compared to neomycin/polymyxin/hydrocortisone for otitis externa pain and was found to provide greater pain relief 4.
- Topical Antibiotics: A systematic review of topical antibiotics for chronic suppurative otitis media found that quinolones (such as ofloxacin and ciprofloxacin) may be effective in improving resolution of ear discharge, but the evidence is limited and of low quality 5.
- Avoiding Neomycin: Due to the potential risk of ototoxicity associated with neomycin, it may be preferable to avoid neomycin-containing ear drops, such as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension 2, 3.
It is essential to consult a healthcare professional to determine the best course of treatment for otitis media with a levofloxacin allergy, as they can assess the individual case and recommend the most suitable option.