Otitis Externa Medication: Antibiotics, Otic, Other, Oral Antibiotics, Analgesics, Antifungals, Other 06/06/18 19.

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Otitis Externa Medication

Updated: Mar 19, 2018
Author: Ariel A Waitzman, MD, FRCSC; Chief Editor: Ravindhra G Elluru, MD, PhD more...

MEDICATION

Medication Summary
Most cases of otitis externa (OE) are caused by superficial bacterial infections and can be
treated with over-the-counter analgesics and topical eardrops. Commonly used topical eardrops
are acetic acid drops, which change the pH of the ear canal; antibacterial drops, which control
bacterial growth; and antifungal preparations. Oral or parenteral antibiotics are reserved for
severe cases. Otic antibiotic and steroid combinations have shown to be highly successful in
treatment. The corticosteroid ingredient decreases inflammation and can help to ease the pain.
These eardrops treat bacterial infection and reduce canal edema. The agents commonly
prescribed for treating otitis externa are associated with cure rates between 87% and 97%. [19]
In severe cases, oral or intravenous (IV) antibiotic therapy and narcotic analgesics may be
required.

Antibiotics
Class Summary
Most cases of OE are caused by superficial bacterial infections. Accordingly, most individuals
with this condition may be treated with topical antibiotic preparations. Some preparations also
contain a corticosteroid ingredient. The small amount of steroid that is present in the solution
can help to ease the pain and edema associated with OE.

Hydrocortisone/neomycin/polymyxin B (Cortisporin, Cortomycin)

Hydrocortisone/neomycin/polymyxin is an antibacterial and anti-inflammatory agent for otic use,
available as a solution or a suspension. It is used to treat steroid-responsive inflammatory
conditions for which a corticosteroid is indicated and in which bacterial infection or a risk of
bacterial infection exists.

Ofloxacin otic
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Otic ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum effect that inhibits

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Otitis Externa Medication: Antibiotics, Otic, Other, Oral Antibiotics, Analgesics, Antifungals, Other 06/06/18 19.03

bacterial growth by inhibiting DNA gyrase. It is available as a 0.3% (3 mg/mL) solution.

Ciprofloxacin otic (Cetraxal)

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Otic ciprofloxacin is a fluoroquinolone that inhibits bacterial synthesis (and thus growth) by
inhibiting DNA gyrase. It has activity against pseudomonads, streptococci, methicillin-resistant
Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and most gram-negative
organisms but has no activity against anaerobes. It is available with or without hydrocortisone.
Cetraxal is an otic solution available as 14 single-use applicators containing 0.25 mL of 0.2%
solution each. Ciloxan is an ophthalmic solution that may be used for OE.

Dexamethasone/tobramycin (TobraDex)
Tobramycin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal
subunits, thereby causing defects in the bacterial cell membrane. Dexamethasone decreases
inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reducing
capillary permeability. TobraDex is an ophthalmic solution that may be used for OE.

Gentamicin ophthalmic (Garamycin, Gentak)

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Gentamicin is an aminoglycoside antibiotic used for gram-negative bacterial coverage. It is

available as an ophthalmic solution that may be used for OE. This solution is a compounded
medication, with each 1 mL containing 3 mg of gentamicin sulfate and 1 mg of betamethasone
sodium phosphate.

Ciprofloxacin and dexamethasone otic (Ciprodex)

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Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis (and thus growth) by
inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and
translation of genetic material. It has activity against pseudomonads, streptococci, MRSA, S
epidermidis, and most gram-negative organisms but not against anaerobes. Dexamethasone
decreases external auditory canal (EAC) inflammation by suppressing migration of PMNs and
reducing capillary permeability; it also relieves pain symptoms.

This otic suspension is indicated for use in OE, as well as for use in otitis media in individuals
with tympanostomy tubes.

Ciprofloxacin and hydrocortisone otic suspension (Cipro HC Otic)

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Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis (and thus growth) by
inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and

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Otitis Externa Medication: Antibiotics, Otic, Other, Oral Antibiotics, Analgesics, Antifungals, Other 06/06/18 19.03

translation of genetic material. It has activity against pseudomonads, streptococci, MRSA, S

epidermidis, and most gram-negative organisms but not against anaerobes. Hydrocortisone
decreases inflammation by suppressing migration of PMNs and reducing capillary permeability.

Otic, Other
Class Summary
Inflammation and accumulated debris allow the growth of bacterial species. This growth is
counteracted by the use of mild acidifying medications, such as acetic acid solutions. These
agents are useful for fungal OE or for mild OE believed to be of bacterial origin. They can also
be useful for prevention.

Acetic acid in aluminum acetate (Borofair)

Aluminum acetate has a drying effect. Acetic acid works well in superficial bacterial infections of
OE.

Hydrocortisone and acetic acid otic solution (VoSoL HC)

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Acetic acid is antibacterial and antifungal; hydrocortisone is anti-inflammatory, antiallergic, and

antipruritic. The combination of the 2 agents is inexpensive and works well in treating superficial
bacterial infections of OE.

Alcohol vinegar otic mix

A homemade mix of 50% rubbing alcohol, 25% white vinegar, and 25% distilled water is as
effective as pharmaceutical acidifying agents and less expensive. It is very useful for prevention
and can be used as a flushing solution for fungal infections.

Oral Antibiotics
Class Summary
Oral antibiotics are used to treat severe infection or cellulitis. Fluoroquinolones are the drugs of
choice by virtue of their coverage of Pseudomonas species.

Ciprofloxacin (Cipro)

View full drug information

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis (and thus growth) by
inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and
translation of genetic material. It has activity against pseudomonads, streptococci, MRSA, S
epidermidis, and most gram-negative organisms but not against anaerobes.

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Otitis Externa Medication: Antibiotics, Otic, Other, Oral Antibiotics, Analgesics, Antifungals, Other 06/06/18 19.04

Analgesics
Class Summary
OE can be quite painful, and control of this pain is essential to quality patient care. Analgesics
ensure patient comfort and may have sedating properties. Inexpensive, simple nonsteroidal anti-
inflammatory drugs (NSAIDs) reduce inflammation and irritation and can be paired with opiates
to improve pain symptoms.

Acetaminophen (Tylenol, FeverAll, Aspirin-Free Anacin, Tylenol Children)

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Over-the-counter acetaminophen is appropriate for most patients. It is the drug of choice for
pain in patients who are known to be hypersensitive to aspirin or NSAIDs, who have upper GI
gastrointestinal (GI) disease, or who are taking oral anticoagulants.

Acetaminophen and codeine (Tylenol #3)

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The combination of acetaminophen and codeine is indicated for the treatment of mild to
moderate pain.

Antifungals, Other
Class Summary

A small but significant percentage of OE cases are due to Aspergillus species or other yeasts
and fungi (otomycosis). Some cases of fungal OE can be treated with acidifying drops; topical
antifungal agents are used to treat otomycosis refractory to these drops. The mechanism of
action of topical antifungal agents usually involves inhibition of the pathways (eg, enzymes,
substrates, and transport) necessary for sterol/cell membrane synthesis or those involved in
altering the permeability of the fungal cell membrane (eg, polyenes).

Clotrimazole 1% otic solution (Lotrimin AF)

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Otic clotrimazole solution is a compounded medication. Clotrimazole is a broad-spectrum

antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing the
death of fungal cells.

Nystatin powder (Nystop, Nyamic, Pedi-Dri)

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Nystatin is a fungicidal and fungistatic antimicrobial obtained from Streptomyces noursei; it is

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Otitis Externa Medication: Antibiotics, Otic, Other, Oral Antibiotics, Analgesics, Antifungals, Other 06/06/18 19.04

effective against various yeasts and yeastlike fungi. It changes the permeability of the fungal cell
membrane after binding to cell membrane sterols, causing the cellular contents to leak.
Treatment should continue until 48 hours after the disappearance of symptoms. Topical
application of nystatin reduces fungal growth.

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