Pediatric Otitis Externa Medication

Class Summary

Most individuals with otitis externa (OE) may be treated with topical antibiotic preparations. Some preparations also contain a corticosteroid ingredient to decrease inflammation.

Hydrocortisone/neomycin/polymyxin

Antibacterial and anti-inflammatory solution for otic use. Treats superficial bacterial infections of external auditory canal. Available as solution or suspension.

Ofloxacin otic (Floxin Otic)

Pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. Available as 0.3% (3 mg/mL) solution.

Ciprofloxacin otic (Cetraxal, Ciloxan)

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but with no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Available with or without hydrocortisone. Cetraxal 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 otitis externa.

Dexamethasone/tobramycin (TobraDex)

Tobramycin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in defective bacterial cell membrane. Dexamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. TobraDex is an ophthalmic solution that may be used for otitis externa.

Gentamicin ophthalmic (Garamycin)

Aminoglycoside antibiotic used for gram-negative bacterial coverage. Available as an ophthalmic solution that may be used for otitis externa.

Ciprofloxacin and dexamethasone otic (Ciprodex)

Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes.

Dexamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Ciprofloxacin and hydrocortisone otic suspension (Cipro HC Otic)

Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes.

Hydrocortisone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Class Summary

These agents are useful in fungal OE or in mild infections believed to be bacterial. They can also be useful for prevention.

Acetic acid in aluminium acetate (Domeboro Otic)

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

Hydrocortisone and acetic acid otic solution (VoSoL HC)

Acetic acid is antibacterial and antifungal; hydrocortisone is anti-inflammatory, antiallergic, and antipruritic. Works well in superficial bacterial infections of OE.

Alcohol vinegar otic mix

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

Class Summary

These agents are used to treat severe infection or cellulitis. Fluoroquinolones are drugs of choice because of Pseudomonas species coverage.

Ciprofloxacin otic (Cipro)

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms but with no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth.