Summer is here...and so are Rxs for swimmer's ear.
This bacterial infection is often due to water trapped in the ear canal. But it can also be caused by earbuds, eczema, etc.
Expect most patients with swimmer's ear who have an intact eardrum to get generic otic Cortisporin (neomycin/polymyxin B/hydrocortisone)...or a quinolone antibiotic drop (ciprofloxacin, ofloxacin).
If patients get Cortisporin, help clarify Rxs that don't specify the dosage form. Cortisporin otic SUSPENSION is usually preferred...since the SOLUTION is more acidic and may be more irritating.
Don't be surprised to see certain EYE drops used in the EAR. This is okay to do...and may cost less. For example, ofloxacin EAR drops cost up to $130/5 mL...ofloxacin EYE drops are about $30/5 mL.
Include a "For the ear" auxiliary label on these Rxs and pull in the pharmacist for counseling...so patients use the med correctly.
Ask patients getting Rxs for swimmer's ear if they have ear tubes or a perforated eardrum. Make a note of this for your pharmacist...so they can check that the med is appropriate.
For example, these patients should avoid Cipro HC (ciprofloxacin/ hydrocortisone), since the product is NOT sterile.
They should also avoid drops that may cause ear toxicity...such as those with alcohol or an "aminoglycoside" (neomycin, etc).
Stay alert for product mix-ups. For instance, inputting "cipro" to find ciprofloxacin otic solution can bring up a slew of products...including Ciprodex, Cipro HC, and oral ciprofloxacin.
Follow your pharmacy policies or contact the payer to determine which drops/mL conversion to use when calculating days' supply. Some require anywhere from 12 to 20 drops/mL, depending on the med.
Send patients with ear pain from swimmer's ear to the pharmacist.
Oral acetaminophen or ibuprofen may offer relief...but OTC ear drops (Ear Pain MD, etc) may mask progression, and other products (Hyland's, sweet oil, etc) aren't likely to help.
Review our chart, Prevention and Treatment of Swimmer's Ear, for costs, dosing, and prevention measures (Swim-Ear, etc).
- Otolaryngol Head Neck Surg 2014;150(Suppl 1):S1-S24
- BMJ Clin Evid 2015;2015:0510
- Am Fam Physician 2012;86(11):1055-61
- Medication pricing by Elsevier, accessed Jun 2020