The authority listing for ciprofloxacin ear drops (Ciloxan) was extended on 1 November 2009 to allow prescribing for children with chronic suppurative otitis media (CSOM) with perforation of the tympanic membrane or a grommet.1 The authority listing of ciprofloxacnin ear drops was previously restricted to CSOM in Aboriginal and Torres Strait Islander people.2

CSOM is a common cause of preventable hearing impairment. Because CSOM usually occurs in the first 5 years of life — when most speech and language development occurs — it may contribute to delayed speech, language and learning3, with negative consequences for socialisation, education and employment.

Ciprofloxacin is not first line because of the risk of resistance but may be useful when >  7 days of therapy is needed, or there is a perforated tympanic membrane or a grommet.4,5 For short-term use (< 7 days), ear drops containing an aminoglycoside (e.g. framycetin) are recommended and appear to be safe.4 However, in the presence of a perforated tympanic membrane or grommet, use of ear drops containing an aminoglycoside is controversial because of the risk of ototoxicity.4,5 Before instilling ear drops, perform aural toilet to remove debris and discharge — that is, 6-hourly, meticulous, gentle dry mopping with rolled tissue spears until the ear canal is dry.4,5