Antimicrobial ear drops for acute diffuse otitis externa when fungal infection is not suspected
For patients with acute diffuse otitis externa when fungal infection is not suspected, use combination corticosteroid and antimicrobial ear drops. Avoid ear drops containing an aminoglycoside (eg framycetin, neomycin) if the patient has a tympanostomy tube in situ, or a tympanic membrane that is known or suspected to be perforated – use a ciprofloxacin-containing ear drop if possible, because they rarely cause inner ear damage. However, ciprofloxacin should be avoided in patients with a history of tendon damage from quinolone useWang, 2020Tran, 2023. If aminoglycoside-containing ear drops cannot be avoided, they can be used with caution because treatment is of short duration.
For treatment of acute diffuse otitis externa when fungal infection (otomycosis) is not suspected, useAbelardo, 2009Hajioff, 2015Kaushik, 2010Lorente, 2014Mosges, 2011Rosenfeld, 2006:
1ciprofloxacin+hydrocortisone 0.2%+1% ear drops, 3 drops into the affected ear, twice daily for 7 days1 ciprofloxacin + hydrocortisone
OR
1dexamethasone+framycetin+gramicidin 0.05%+0.5%+0.005% ear drops, 3 drops into the affected ear, 3 times daily for 7 days. dexamethasone + framycetin + gramicidin
If ciprofloxacin or an aminoglycoside cannot be used, an alternative is:
flumetasone+clioquinol 0.02%+1% ear drops, 3 drops into the affected ear, twice daily for 7 days. flumetasone + clioquinol
Advise patients to tilt their head to the opposite side after instilling the ear drops, and to apply gentle pressure to the tragus (by pressing on it repeatedly without causing pain) for 30 seconds.