From the Guidelines
For external otitis, the best treatment is antibiotic ear drops, and all eardrops approved for treating acute otitis externa are highly effective, with no consistent advantage shown for any one specific drug. When choosing an eardrop, factors such as cost, dosing frequency, status of the eardrum, and the doctor’s experience should be considered 1. It is essential to inform the doctor about any prior ear surgery, presence of an opening in the eardrum, or ear tube, as this may require the use of an eardrop approved for middle ear use 1.
- Key considerations for treatment include:
- Using eardrops for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection 1
- Avoiding scratching or touching the ear and not inserting anything into the ear canal, including cotton-tipped swabs 1
- Covering the opening of the ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry 1
- Potential side effects of eardrops include local rash, itching, irritation, or discomfort, but these are rarely severe enough to require stopping the medication 1.
- If symptoms persist beyond 7 days or do not improve within 48-72 hours of treatment, medical attention should be sought as additional interventions may be needed 1.
From the FDA Drug Label
Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. Ofloxacin otic solution is indicated for the treatment of otitis externa.
The best ear drops for external otitis are ciprofloxacin (OTIC) and ofloxacin (OTIC), as they are both indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 2, 3, 2.
- Ciprofloxacin (OTIC) is administered twice daily for 7 days 2, 2.
- Ofloxacin (OTIC) is administered once daily for 7 days for patients 13 years and older, and once daily for 7 days for pediatric patients from 6 months to 13 years old 3.
From the Research
Ear Drops for External Otitis
- The most effective ear drops for external otitis are those that contain antimicrobial or antibiotic properties, such as acetic acid, aminoglycosides, polymyxin B, and quinolones 4.
- Studies have shown that ofloxacin otic solution is as safe and effective as neomycin/polymyxin B/hydrocortisone for the treatment of otitis externa in adults and children 5.
- Ciprofloxacin has also been found to be a useful and effective agent in the local therapy of otitis externa, with rapid eradication of bacterial pathogens and significant clinical improvement 6.
- A comparison of ciprofloxacin/dexamethasone with neomycin/polymyxin/hydrocortisone found that ciprofloxacin/dexamethasone provided greater pain relief and reduced inflammation and edema in patients with acute otitis externa 7.
- However, it's worth noting that the organisms most often causing otitis externa appear to be developing resistance to neomycin and polymyxin B, but not to ofloxacin 8.
Treatment Options
- Topical antimicrobials or antibiotics are the treatment of choice in uncomplicated cases of otitis externa 4.
- The choice of treatment depends on various factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost 4.
- Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact 4.
- Oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 4.