Most persons with OE do not require oral medications. Oral antibiotics are generally reserved for patients with fever, immunosuppression, diabetes, adenopathy, or an infection extending outside of the ear canal. They should be given to individuals with cellulitis of the face or neck skin or to persons in whom severe edema of the ear canal limits penetration of topical agents.
Most experts prefer topical fluoroquinolones because of their antimicrobial spectrum, anti-inflammatory effects, and lower risk for allergic reactions. However, they are more expensive than other options and may not be reimbursed by all insurers in the United States. Other, less expensive products which are reasonable alternatives include 2% acetic acid with 1% hydrocortisone and neomycin/polymyxin B/hydrocortisone otic (Cortisporin Otic).
Fluoroquinolones are not associated with ototoxicity, and ofloxacin is safe in cases of a perforated tympanic membrane. The combination of oral antibiotics with otic antibiotic solutions has not been shown to improve treatment success rates.
For more on the treatment of OE, read here.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Russell W. Steele. Fast Five Quiz: How Familiar Are You With Otitis Externa? - Medscape - May 17, 2016.