From the Guidelines
For external otitis (swimmer's ear) and ear fullness pain, antibiotic ear drops containing fluoroquinolones like ciprofloxacin or ofloxacin combined with steroids are typically most effective. A common prescription is Ciprodex (ciprofloxacin 0.3% with dexamethasone 0.1%), used as 4 drops in the affected ear twice daily for 7 days, as recommended by the clinical practice guideline: acute otitis externa 1. Before applying drops, clean the ear canal gently with a warm washcloth and lie with the affected ear up for 5 minutes after application to ensure the medication penetrates properly. Over-the-counter options include acetic acid solutions like Vosol, which create an acidic environment that discourages bacterial growth. For severe pain, oral pain relievers like ibuprofen or acetaminophen can supplement the ear drops. The antibiotic component fights infection-causing bacteria, while the steroid reduces inflammation and swelling, providing faster pain relief. Some key points to consider when using ear drops for external otitis include:
- Allowing the drops to penetrate the ear canal for 3 to 5 minutes after application, as instructed in the clinical practice guideline: acute otitis externa executive summary 1
- Keeping the ear dry to prevent further irritation
- Avoiding cleaning the ear yourself, as this can cause damage to the ear canal or eardrum
- Not removing any wick that may be placed in the ear canal unless instructed to do so by a clinician If symptoms don't improve within 48-72 hours of treatment, or if you experience fever, severe pain, or drainage, seek medical attention as these may indicate a more serious condition requiring different treatment, as noted in the clinical practice guideline: acute otitis externa 1. It's also important to be aware of potential complications, such as allergic contact dermatitis, which can occur with the use of certain ear drops, as discussed in the clinical practice guideline: acute otitis externa executive summary 1.
From the FDA Drug Label
The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness which may result from the instillation of a cold solution. The patient should lie with the affected ear upward, and then the drops should be instilled This position should be maintained for five minutes to facilitate penetration of the drops into the ear canal.
Ofloxacin (OTIC) is recommended for the treatment of otitis externa, which is an infection of the outer ear and ear canal. The dosage regimen for ofloxacin (OTIC) is as follows:
- For pediatric patients (from 6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for 7 days.
- For patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear once daily for 7 days. To administer the drops, the patient should lie with the affected ear upward, and the drops should be instilled into the ear canal. The position should be maintained for 5 minutes to facilitate penetration of the drops into the ear canal 2.
From the Research
Ear Drops for External Otitis and Ear Fullness Pain
- The most effective ear drops for external otitis and ear fullness pain are those that contain antimicrobial or antibiotic properties, such as ofloxacin or ciprofloxacin, with or without corticosteroids 3, 4, 5, 6, 7.
- Ofloxacin otic solution has been shown to be as effective and safe as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension in treating otitis externa in children and adults, with rapid and comparable pain relief 3, 6.
- Ciprofloxacin/dexamethasone has been compared to neomycin/polymyxin/hydrocortisone for otitis externa pain, with results showing higher percentages of ciprofloxacin/dexamethasone-treated patients having relief of severe pain over time 7.
- The choice of treatment depends on various factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost 5.
- Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact, but there is a risk of ototoxicity associated with neomycin 3, 4, 5.
Comparison of Ear Drops
- Ofloxacin otic solution has been shown to be equivalent to neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension in terms of clinical and microbiological cure rates 3, 6.
- Ciprofloxacin/dexamethasone has been shown to provide greater pain relief and rapid reduction in severe pain compared to neomycin/polymyxin/hydrocortisone 7.
- The MICs of neomycin and polymyxin B have increased over time, indicating a decline in susceptibility of pathogens to these antibiotics, whereas the MICs of ofloxacin have remained stable 4.