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. Ciprofloxacin otic solution, 0.2% is a sterile, preservative-free otic solution of ciprofloxacin hydrochloride equivalent to 0.2 % ciprofloxacin (0.5 mg in 0.25 mL) in each single-dose container.
Topical antibiotic for acute otitis externa: Ciprofloxacin otic solution, 0.2% is indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 1.
- The dosage is twice daily (approximately 12 hours apart) for 7 days.
- Contraindications include history of hypersensitivity to ciprofloxacin.
- Adverse reactions may include application site pain, ear pruritus, fungal ear superinfection, and headache.
From the Research
For acute otitis externa, the recommended first-line topical antibiotic treatment is ciprofloxacin 0.3% with dexamethasone 0.1% otic suspension, 4 drops into the affected ear twice daily for 7 days, as it has been shown to be effective against Pseudomonas aeruginosa and Staphylococcus aureus, the most common pathogens in otitis externa, and has a lower treatment failure rate compared to other topical antibiotics 2.
Key Considerations
- The ear canal should be gently cleaned of debris before application of the antibiotic suspension 3.
- For severe cases with significant canal edema, an ear wick may be inserted to facilitate medication delivery, which can be removed after 48-72 hours when swelling subsides 3.
- Patients should avoid water exposure during treatment and can use earplugs or cotton balls coated with petroleum jelly when showering 3.
- If there are signs of spreading infection beyond the ear canal or in immunocompromised patients, oral antibiotics may be necessary as an adjunct to topical therapy 3.
Alternative Options
- Ofloxacin 0.3% otic solution, 5-10 drops into the affected ear twice daily for 7 days, is also an effective alternative 4.
- Neomycin/polymyxin B/hydrocortisone preparations can be used as a first-line therapy when the tympanic membrane is intact, but may have a higher treatment failure rate compared to ciprofloxacin/dexamethasone 2.
Evidence Summary
The most recent and highest quality study 5 suggests that antiseptic, steroid, and antibiotic monotherapies are all effective for the management of acute otitis externa, but the study 2 provides more specific guidance on the effectiveness of ciprofloxacin/dexamethasone compared to other topical antibiotics.