Topical Ciprofloxacin in Long-Lasting Otorrhea

In September 1997 we participated in the Croatian Congress of Pharmacology in Rijeka, Croatia, with a poster presenting our work at the Clinic of Otorhinolaryngology, Clinical Hospital Centre of Rijeka entitled "Local Application of Ciprofloxacin in Therapy of Long-Lasting Otorrhea."

The purpose of our study was to investigate the efficiency of the simplified therapy of otorrhea by the application of ciprofloxacin once daily, and to compare the obtained results with the results from the literature where the same drug was administered 2 to 4 times daily.

The advantages of topical ciprofloxacin have already been confirmed by other authors.^{1 - 7} They have proved its efficiency with negligible adverse effects.

Until recently, there was no otologic preparation of ciprofloxacin on the market, and ampules for parenteral therapy had to be diluted for local application.This was not only impractical but also caused the great dosage differences used by different authors.^{1 - 7}

In the August 1994 issue of the ARCHIVES, there was even a letter by Tutkun⁵ about the dosage difference in an article of Esposito et al³ issued in May 1990. It turned out to be a typographic mistake; nevertheless, such misunderstandings would not happen if there was a standard preparation and a well-defined dosage for topical usage of ciprofloxacin in otorrhea.

Thus far in the published reports, topical ciprofloxacin is applied several times daily (2-4 times), which is not compatible with the so-called patient compliance.⁸ This has urged us to apply ciprofloxacin once daily by local instillation into the ear. Our main purpose was to obtain a "dry ear" with the simplest, cheapest, yet harmless and efficient therapy.

In cases of ciprofloxacin-sensitive bacterium (following the antibiogram to avoid resistance),⁶ a 0.2% solution of ciprofloxacin, ie, 1 ampule (10 mL), which contains 100 mg of ciprofloxacin in the lactate form diluted with 40 mL of physiologic solution (0.9% sodium chloride) in the quantity of 5 mL per patient, was applied locally once daily for 7 days. Seven days after the last administration of the drug a control swab was taken.

Forty patients were examined—all with a ciprofloxacin-sensitive bacterium isolated from the ear discharge. The clinical success of dry ear was achieved in all the patients, ie, 100%, but 6 patients had both local and systematic therapy with ciprofloxacin; therefore, strictly local treatment was efficient in 34 patients (85%). Bacteriological success was reached in 35 patients (87.5%).

Our results are comparable with the previously published treatments.^{1 - 7}

The ciprofloxacin solution is stable over 14 days,⁷ therefore it will be efficient for 24 hours in the auditory channel. Giving the drug once daily the therapy is simplified according to patient compliance and yet as effective as the previous trials with topical administration several times daily. This is in accordance with our experiences with topical gentamicin once daily, published in 1983.⁹

I would like to hear the opinion and experiences, if there are any, of others about this simplified version of treating otorrhea.

Also, Floxin Otic, as a standard otologic preparation of ciprofloxacin, has been recently available on the open market, although there is already a considerable number of reports about the advantages of local therapy for otorrhea.^{1 ,3 - 4 ,10} However, we did not dispose of it during our research and its appearance justifies our work.

This otologic preparation should exclude all the above-mentioned misunderstanding in dosage, answer the opened questions of topical ciprofloxacin therapy, and hopefully be useful both to physicians and patients in the treatment of "secerning" ear.