Table 1.

Topical antimicrobial otic therapies for patients with otitis externa

TREATMENT CLASS	ACTIVE AGENTS	POPULATION	DOSAGE	OTOTOXIC^*	NOTES
Antibiotic otic drops	10,000 IU of polymyxin B and 0.025 mg of gramicidin per mL³²	≥6 y	1-2 drops 4 times a day for 5-7 days	Yes	Over the counter
	Ofloxacin 0.3%³³	≥6 mo	Ages 6 mo to 13 y: 5 drops daily for 7 days Older than 13 y: 10 drops once daily for 7 days	No	Prescription
	Ciprofloxacin 0.2%³⁴	≥1 y	Instill 1 container (0.25 mL) in ear twice a day for 7 days	No	Prescription
Combined antibiotic otic drops	10,000 IU of polymyxin B and 50 mg of lidocaine hydrochloride per mL³⁵	≥6 y	Instill 3-4 drops 4 times a day for 5-7 days	Yes	Over the counter
	Ciprofloxacin hydrochloride 0.3% and dexamethasone 0.1%³⁶	≥6 mo	4 drops twice a day for 7 days	No	Prescription Ciprofloxacin ophthalmic drops can be used in instances of ciprofloxacin-dexamethasone shortages³⁷
	Acetic acid 2% and hydrocortisone 1%³⁸	≥3 y	3-5 drops 3 or 4 times a day	Yes	Prescription
	Neomycin sulfate 0.35%, 10,000 IU of polymyxin B sulfate, and hydrocortisone 1%³⁹	≥2 y	4 drops 3 or 4 times a day for a maximum of 10 days	Yes	Prescription
	Ciprofloxacin hydrochloride 0.3% and fluocinolone acetonide 0.025%⁴⁰	>6 mo	Instill 1 container (0.24 mL) in ear twice a day for 7 days	No	Prescription
Antiseptic drops	Isopropyl alcohol 95%⁴¹	No guidelines	Apply 4-5 drops per ear once after water or moisture contact	Yes	Over the counter
Antifungal medication	Flumethasone pivalate 0.02% and clioquinol 1%⁴²	≥2 y	2-3 drops daily for fewer than 10 days	Yes	Prescription
	Voriconazole 1%⁴³·⁴⁴	No guidelines	No guidelines; suggest 3 drops 3-4 times daily for 14 days^43,44	No	Prescription, requires compounding, and is expensive
	Clotrimazole 1%	No guidelines	No guidelines; suggestions include a coated wick changed every 3 days for 1 wk^24,45	No	Over the counter

↵* Contraindicated in patients with perforated tympanic membrane.