Topical (otic) preparations for external otitis*

Topical preparation	Brand name (United States)	Usual dosage (adult)*	Corticosteroid	pH	Preservative	Notes
Acidifying/antiseptic solution
Acetic acid 2% otic solution	Generic (formerly Acetasol)	3 to 5 drops four to six times daily	None	3.5 to 5	No additional	Avoid if TM is known or suspected to be nonintact (acidic preparation)^¶ Combination with corticosteroid (refer to next row) generally preferred by UpToDate Contains boric acid
Acidifying/antiseptic and corticosteroid combination
Acetic acid 2% and hydrocortisone 1% otic solution	Acetasol HC	4 to 6 drops three or four times daily	Hydrocortisone	2 to 4	No additional	Avoid if TM is known or suspected to be nonintact (acidic preparation)^¶ Often used for treatment of mild disease Contains 3% propylene glycol (drying agent) and benzethonium for promoting tissue penetration
Antibiotic and corticosteroid combinations
Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension	Ciprodex	4 drops twice daily	Dexamethasone	Buffered	Benzalkonium chloride	Non-ototoxic; may use if TM is known or suspected to be nonintact Often used for treatment of mild to moderate disease Contains boric acid
Ciprofloxacin 0.2% and hydrocortisone 1% otic suspension	Cipro HC	3 drops twice daily	Hydrocortisone	Buffered	Benzyl alcohol	Avoid if TM is known or suspected to be nonintact (nonsterile preparation)^¶ Often used for treatment of mild to moderate disease
Neomycin, polymyxin B, and hydrocortisone otic suspension (each mL contains 3.5 mg neomycin, 10,000 units polymyxin B, and 10 mg hydrocortisone)	Generic (formerly Cortisporin otic)	4 drops three or four times daily	Hydrocortisone	Acidic	Potassium metabisulfite	Avoid if TM is known or suspected to be nonintact (aminoglycoside-containing formulation)^¶ Suspension is less irritating than solution
Neomycin 0.33%, colistin 0.3%, and hydrocortisone 1% otic suspension	Cortisporin-TC	5 drops three or four times daily	Hydrocortisone	5	Thimerosal	Avoid if TM is known or suspected to be nonintact (aminoglycoside-containing formulation)^¶ Contains thonzonium for promoting tissue penetration
Tobramycin 0.3% and dexamethasone 0.1% ophthalmic suspension^Δ	TobraDex	4 drops three or four times daily	Dexamethasone	Buffered	Benzalkonium chloride	Avoid if TM is known or suspected to be nonintact (aminoglycoside-containing formulation)^¶
Antibiotic
Solutions
Ciprofloxacin 0.2% otic solution	Cetraxal	0.25 mL twice daily	None	Buffered	None; single-use container	Non-ototoxic; may use if TM is known or suspected to be nonintact Supplied as 0.5 mg per 0.25 mL sterile individual use containers; contains povidone
Ofloxacin 0.3% otic solution	Generic (formerly Floxin otic)	10 drops once daily	None	6.5	Benzalkonium chloride	Non-ototoxic; may use if TM is known or suspected to be nonintact
Health care provider-administered suspension
Ciprofloxacin 6% otic suspension	Otiprio	0.2 mL as a single dose	None	Buffered	None; single-use container	Prepared and administered by health care provider as a single 0.2 mL (12 mg) dose to external ear canal of each affected ear Costlier than most other options

This table lists common topical preparations for treating uncomplicated mild or moderate external otitis. An initial course of 7 days is usually prescribed, which may be extended by an additional 7 days if improving but not resolved. Lack of improvement or worsening symptoms within 2 to 3 days warrants reevaluation. For pain management, oral analgesics (acetaminophen, NSAID) are recommended; avoid topical (otic) analgesics. For clinical management and administration detail, refer to UpToDate topic review, separately available treatment algorithm, and Lexicomp drug monographs.

TM: tympanic membrane.

* Daily dose administered in affected ear; to enhance delivery, patients should be educated on proper administration.

¶ In patients with a suspected or confirmed nonintact TM, avoid nonsterile and ototoxic preparations (ie, containing aminoglycosides or alcohol) as well as acidic preparations as they may reach the middle ear and cause worsening symptoms, pain, and loss of hearing.

Δ Available only as ophthalmic preparation but can be applied directly to the ear to treat acute external otitis.

Additional data from:

Rosenfeld RM, Schwartz SR, Canon CR, et al. Clinical practice guideline: Acute otitis externa. Otolaryngol Head Neck Surg 2014; 150:S1.
United States prescribing information available at National Library of Medicine DailyMed website (https://dailymed.nlm.nih.gov/dailymed/).

Graphic 67418 Version 13.0

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Topical (otic) preparations for external otitis*