Nadia asked
I apparently have swimmer's ear. It’s going on 4 weeks, I've had several different antibiotics, nothing is helping. I don't know what to do anymore. It’s very painful.
Answer
For most individuals, topical antibiotics are the recommended treatment for swimmer's ear (also known as otitis externa).
Systemic antibiotics are generally not recommended for the treatment of swimmer's ear for a variety of reasons, including:
- Systemic antibiotics are no more effective than topical antibiotics.
- Using systemic antibiotics increases the risk of side effects.
- Overuse of systemic antibiotics can lead to bacterial resistance.
In fact, the guidelines for the treatment of swimmer's ear, published by The American Academy of Otolaryngology, strongly recommend against the use of systemic antibiotics for the reasons above, unless in certain, uncommon situations (as will be discussed below).
Best Topical Antibiotics For Swimmer's Ear
As swimmer's ear is most commonly caused by a bacterial infection of the ear canal, topical antibiotics are utilized as they are able to reach the site of action in very high concentrations. Below is a list of the most common and effective antibiotic drugs for swimmer's ear:
- Acetic Acid 2.0%
- Acetic Acid 2.0% with hydrocortisone 1.0% (Acetasol HC)
- Ciprofloxacin 0.2% with hydrocortisone 1.0% (Cipro HC)
- Ciprofloxacin 0.3% with dexamethasone 0.1% (CiproDex)
- Neomycin, Polymyxin B, hydrocortisone (Cortisporin Otic)
Ciprofloxacin, neomycin and polymyxin B are all classified as antibiotics.
Acetic acid, while not technically an antibiotic, is classified as an antiseptic and is effective for curing bacterial swimmer's ear infections.
Hydrocortisone and dexamethasone are steroids and are often added to topical antibiotic preparations to help relieve inflammation and itchiness.
Most studies evaluating the effectiveness of one antibiotic over another generally find no significant differences in cure rates. Cure rates of topical products for the treatment of swimmer's ear are all around 60-80% when used correctly for 7 to 10 days.
However, in studies that do find that one antibiotic is superior to another, ciprofloxacin antibiotics generally come out on top. Therefore, based on the data available, Cipro HC and CiproDex may be the best and most effective antibiotics available for swimmer's ear, but this isn't conclusive.
When Do You Use Systemic Antibiotics For Swimmer's Ear?
If topical antibiotics are not working to clear your swimmer's ear infection, there are a few things to consider.
First and foremost, it is important that you are administering the topical antibiotics correctly.
- Gently clear ear of debris (e.g. wax, dry skin etc...).
- Apply drops while lying down, with the infected ear facing upward. Drops should be placed on the side of the ear canal and allowed to run down until the canal is filled.
- It sometimes helps to gently move/adjust the ear by tugging on the earlobe to eliminate trapped air and to ensure the drops will completely fill the ear canal.
- If there is considerable edema or inflammation, it may be difficult for the ear drops to completely fill the canal. In this case, an ear wick can be used. If an ear wick is not an option, systemic antibiotics may need to be used.
If antibiotic ear drops are being administered correctly and are not working, it is important to have your infection re-assessed. It is very possible you have a fungal infection instead, known as fungal otitis externa.
Below are some common indications for the use of systemic antibiotics for swimmer's ear infections:
- Significant edema or inflammation that precludes the drops from filling the ear canal or if topical antibiotics cannot be administered appropriately.
- Individual is immunocompromised (e.g. HIV).
- The infection has spread beyond the ear canal into the surrounding skin or the middle ear.
Summary
- Topical antibiotics are considered first-line therapy for the treatment of swimmer's ear.
- All indicated topical antibiotics for the treatment of swimmer's ear are comparable in their efficacy.
- However, limited data suggests that ciprofloxacin antibiotics may be slightly more effective.
- Systemic antibiotics are not commonly used for swimmer's ear infections unless there are specific circumstances.
