When choosing an appropriate ear drop, consider which is the most appropriate for the likely type of infection, the most suitable formulation and what is funded and available:
Ciprofloxacin + hydrocortisone (Ciproxin HC)*
Child and adult: 3 drops, twice daily, for five to seven days
Fluroquinolone ear drops are generally recommended first-line in many guidelines on the balance of benefit and safety, but these are not currently funded and resistance needs to be considered. Discuss the possibility of self-funding.
Dexamethasone + framycetin + gramicidin (Sofradex)
Child and adult: 2 – 3 drops, three to four times daily, for five to seven days
In practice, Sofradex is often used first-line (unless there is suspicion of Pseudomonas or a framycetin/gramicidin-resistant organism) as it is a thin fluid, generally well-tolerated and currently partly funded.
Flumethasone + clioquinol (Locorten Vioform)
Child > 2 years and adult: 2 – 3 drops, twice daily, for five to seven days
This ear drop is most appropriate for fungal/yeast infections in addition to aural microsuction.
Triamcinolone + neomycin + gramicidin + nystatin (Kenacomb)
Child and adult: 2 – 3 drops, two to four times daily, for five to seven days
Kenacomb is an alternative to Locorten-Vioform, although these drops can be difficult to instil (thick yellow liquid) and their appearance can confound whether an infection is settling or not.
*Ciprofloxacin eye drops 0.3% (five drops administered into the ear, twice daily for nine days) are funded for the second-line treatment of CSOM (unapproved indication). These drops do not contain an anti-inflammatory component that is usually recommended to treat CSOM and so may be less effective than combination drops.
N.B. Avoid using drops for longer than seven days as there is increasing risk of ototoxicity, and a secondary infection, e.g. fungal, can develop.