Otitis Externa Empiric Therapy 

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Empiric therapeutic regimens for otitis externa are outlined below, including those for chronic otitis externa, uncomplicated bacterial infection, uncomplicated fungal infection, and malignant otitis externa. ^{[1, 2, 3, 4, 5, 6, 7, 8]}

See the list below:

Neomycin-polymyxin B–hydrocortisone otic 5 drops in the affected ear QID

See the list below:

Acetic Acid 2% with or without hydrocortisone otic 4 drops in the affected ear QID for 7d or 

Ciprofloxacin-hydrocortisone otic 3 drops in the affected ear BID for 7d or

Neomycin-polymyxin B–hydrocortisone otic 4 drops in the affected ear TID or QID for 10d or

Ofloxacin 0.3% otic 10 drops in the affected ear once daily for 7d

See the list below:

Clotrimazole 1% otic 4 drops in the affected ear QID for 7d

See the list below:

Ciprofloxacin 400 mg IV q12h for 14d or

Cefepime 2 g IV q12h or

Piperacillin-tazobactam 3.375 mg IV q8h

Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev. 2010 Jan 20. CD004740. [Medline].

Rahman A, Rizwan S, Waycaster C, Wall GM. Pooled analysis of two clinical trials comparing the clinical outcomes of topical ciprofloxacin/dexamethasone otic suspension and polymyxin B/neomycin/hydrocortisone otic suspension for the treatment of acute otitis externa in adults and children. Clin Ther. 2007 Sep. 29(9):1950-6. [Medline].

Roland PS, Belcher BP, Bettis R, Makabale RL, Conroy PJ, Wall GM, et al. A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa. Am J Otolaryngol. 2008 Jul-Aug. 29(4):255-61. [Medline].

Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006 Apr. 134(4 Suppl):S24-48. [Medline].

Wall GM, Stroman DW, Roland PS, Dohar J. Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J. 2009 Feb. 28(2):141-4. [Medline].

Lee S, Rosh AJ. Otitis Externa in Emergency Medicine. Medscape Reference. Available at http://emedicine.medscape.com/article/763918-overview. Accessed: Apr 20, 2010.

[Guideline] Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb. 150 (1 Suppl):S1-S24. [Medline]. [Full Text].

Crowson MG, Schulz KC, Tucci DL. Provider and patient drivers of ototopical antibiotic prescription variability. Am J Otolaryngol. 2015 Nov-Dec. 36 (6):814-9. [Medline].

Samuel Lee, MD, MS, FACEP Attending Physician, Department of Emergency Medicine, St Joseph Medical Center, St Clare Medical Center, and Swedish Issaquah Medical Center

Samuel Lee, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Otitis Externa Empiric Therapy 

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