Can Ciprodex and Augmentin Be Given Together?
Yes, topical ciprofloxacin-dexamethasone (Ciprodex) ear drops and oral amoxicillin-clavulanate (Augmentin) can be safely administered together for concurrent otitis externa and acute bacterial sinusitis in this 57-year-old adult.
Rationale for Concurrent Use
There are no contraindications or clinically significant drug interactions between topical ciprofloxacin-dexamethasone and oral amoxicillin-clavulanate. These medications target different anatomical sites and work through complementary mechanisms:
Topical ciprofloxacin-dexamethasone delivers extremely high local concentrations (3000 mcg/mL) directly to the external auditory canal, far exceeding the minimum inhibitory concentration (MIC) of relevant pathogens while achieving negligible systemic absorption 1, 2.
Oral amoxicillin-clavulanate provides systemic coverage for acute bacterial rhinosinusitis, with high-dose formulations (4 g/day for adults) demonstrating excellent activity against Streptococcus pneumoniae and β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 3.
Treatment Approach for Each Condition
For Uncomplicated Otitis Externa:
First-line therapy is topical ciprofloxacin-dexamethasone (3-4 drops twice daily for 7 days), which has demonstrated superior clinical cure rates (90.9%) and microbiologic eradication (94.7%) compared to older aminoglycoside-containing preparations 4.
The American Academy of Otolaryngology-Head and Neck Surgery recommends limiting topical therapy to a single course of no more than 10 days to prevent fungal external otitis (otomycosis) that can occur with prolonged quinolone use 3, 5.
Clean the ear canal of debris before administering drops by blotting the canal opening or using gentle suction, and have the patient "pump" the tragus several times after instillation to ensure medication reaches the infection site 3, 5.
For Acute Bacterial Sinusitis:
High-dose amoxicillin-clavulanate (4 g amoxicillin with 250 mg clavulanate daily in divided doses) is appropriate first-line therapy for adults with acute bacterial rhinosinusitis, providing calculated clinical efficacy of 91-92% and bacteriologic efficacy of 97-99% 3.
This formulation overcomes penicillin-resistant S. pneumoniae through higher dosing and covers β-lactamase-producing organisms through the addition of clavulanate 3, 6.
Key Clinical Considerations
Systemic antibiotics are NOT routinely indicated for uncomplicated otitis externa but are appropriate when 3:
- Cellulitis of the pinna or adjacent skin is present
- Concurrent bacterial infection (such as sinusitis) exists
- Signs of severe infection (high fever, severe otalgia, toxic appearance) are present
- The patient is immunocompromised
In this case, the oral amoxicillin-clavulanate is treating the sinusitis, not the otitis externa, making concurrent use entirely appropriate.
Important Pitfalls to Avoid
Do not use aminoglycoside-containing ear drops (neomycin, gentamicin, tobramycin) if there is any concern about tympanic membrane perforation, as these carry ototoxicity risk 3, 5.
Reassess if otorrhea persists beyond 7-10 days despite topical therapy, as culture may be needed to guide further treatment 5.
Prevent water entry into the ear canal during active otitis externa treatment 3.
If symptoms of either condition worsen or fail to improve after 48-72 hours, reevaluation is necessary 3.