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Topical (otic) preparations for external otitis*

Topical (otic) preparations for external otitis*
Topical preparation Brand name
(United States)		 Usual dosage* Corticosteroid pH Preservative Notes
Adults Children
Acidifying/antiseptic solution
Acetic acid 2% otic solution Generic
(formerly Acetasol or VoSol)		 3 to 5 drops three to four times daily Children ≥3 years and adolescents: 3 to 5 drops three to four 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
Acidifying/antiseptic and corticosteroid combination
Acetic acid 2% and hydrocortisone 1% otic solution Acetasol HC 3 to 5 drops three to four times daily Children ≥3 years and adolescents: 3 to 5 drops three to 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 Infants ≥6 months, children, and adolescents: 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 Children and adolescents: 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 Children and adolescents: 3 drops three to 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 Children ≥1 year and adolescents: 4 drops three to 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 suspensionΔ TobraDex 4 drops three or four times daily Limited data in pediatric patients 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 Children and adolescents: 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

Infants ≥6 months and children: 5 drops once daily

Adolescents: 10 drops once daily

 None 6.5 Benzalkonium chloride
  • Non-ototoxic; may use if TM is known or suspected to be nonintact
This table lists common topical preparations that can be used to treat external otitis. If the ear canal is too swollen for drops to pass deep into the canal, an aural wick should be placed to facilitate delivery of the drug. An initial course of 7 days is usually prescribed, which may be extended to up to 14 days if the infection does not resolve within 7 days. Lack of improvement or worsening symptoms within 2 to 3 days warrants reevaluation. For pain management, oral analgesics (acetaminophen, NSAID) are generally sufficient; topical (otic) analgesics should not be used. Refer to separate UpToDate content on otitis externa for additional details, including choice of topical therapy and other clinical management. For additional information on specific topical agents, refer to drug monographs included within UpToDate.

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.

Data from: UpToDate Lexidrug. More information available at https://online.lexi.com/.

Additional data from:

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