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Topical preparations for external otitis*

Topical preparations for external otitis*
Topical preparation Brand name
(United States)
Antiseptic Glucocorticoid pH Preservative Notes
Acidifying/antiseptic solution
Acetic acid 2% otic solution Generic
(formerly Acetasol)
Acetic acid None 3.5 to 5 No additional Avoid use of acidifying antiseptic agents if tympanic membrane is known or suspected to be non-intact; contains boric acid
Acidifying/antiseptic and glucocorticoid combination
Acetic acid 2% and hydrocortisone 1% otic solution Acetasol HC, VoSol HC otic Acetic acid Hydrocortisone 2 to 4 No additional Avoid use of acidifying antiseptic agents if tympanic membrane is known or suspected to be non-intact; contains propylene glycol (drying agent) and benzethonium for promoting tissue penetration
Antibiotic and glucocorticoid combinations
Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension Ciprodex None Dexamethasone Buffered Benzalkonium chloride Contains boric acid
Ciprofloxacin 0.2% and hydrocortisone 1% otic suspension Cipro HC otic None Hydrocortisone Buffered Benzyl alcohol  
Neomycin 0.35%, polymyxin B 10,000 units/mL, and hydrocortisone 0.5% otic solution Cortisporin otic None Hydrocortisone Acidic Potassium metabisulfite Avoid use of topical aminoglycosides if tympanic membrane is known or suspected to be non-intact
Neomycin 0.33%, colistin 0.3%, and hydrocortisone 1% otic suspension Coly-Mycin S, Cortisporin TC None Hydrocortisone 5 Thimerosal Avoid use of topical aminoglycosides if tympanic membrane is known or suspected to be non-intact; contains thonzonium for promoting tissue penetration
Gentamicin 0.3% and prednisolone 1% ophthalmic suspension Pred-G None Prednisolone 5.4 to 6.6 Benzalkonium chloride Avoid use of topical aminoglycosides if tympanic membrane is known or suspected to be non-intact
Tobramycin 0.3% and dexamethasone 0.1% ophthalmic suspension TobraDex None Dexamethasone Buffered Benzalkonium chloride Avoid use of topical aminoglycosides if tympanic membrane is known or suspected to be non-intact
Gentamicin 0.3% and betamethasone 0.1% otic solution GarasoneΔ
(not available in United States)
None Betamethasone Buffered Benzalkonium chloride Avoid use of topical aminoglycosides if tympanic membrane is known or suspected to be non-intact; contains boric acid
Antibiotic
Solutions
Ciprofloxacin 0.2% otic solution Cetraxal otic None None Buffered None; single-use container Supplied as 0.5 mg per 0.25 mL individual use containers; contains povidone
Ofloxacin 0.3% otic solution Generic
(formerly Floxin otic)
None None 6.5 Benzalkonium chloride  
Health care provider-administered suspension
Ciprofloxacin 6% otic suspension Otiprio None 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

Glucocorticoid suspension
Dexamethasone 0.1% ophthalmic suspension Maxidex None Dexamethasone Buffered Benzalkonium chloride  
* Topical preparations listed in chart are intended for use with an intact tympanic membrane. In cases where tympanic membrane is not intact, please refer to preparations discussed in UpToDate topics on suppurative otitis media.
¶ These drugs or drug combinations are available only in ophthalmic preparations but can be applied directly to the ear to treat acute external otitis.
Δ Not available in the United States. Product shown is available in Canada and other countries.
Prepared with data from:
  1. Rosenfeld RM, Schwartz SR, Canon 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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