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
- Pharmaceutical Benefits Advisory Committee. Positive recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC) in July 2009 relating to the listing of drugs on the Pharmaceutical Benefits Scheme (PBS). Canberra: Australian Government Department of Health and Ageing, 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbacrec-jul09-positive (accessed 26 August 2009).
- National Prescribing Service. Ciprofloxacin ear drops (Ciloxan) for chronic suppurative otitis media in Aboriginal and Torres Strait Islander people. NPS RADAR In Brief, April 2007. Sydney: National Prescribing Service, 2007. http://www.nps.org.au/health_professionals/publications/nps_radar/current/april_2007/brief_item_ciprofloxacin_ear_drops_ciloxan_for_chronic_suppurative _otitis_media_in_aboriginal_and_torres_strait_islander_people (accessed 7 September 2009).
- Macfadyen CA, Acuin JM, Gamble C. Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforation. Cochrane Database Syst Rev 2005:CD004618.
- Antibiotic Writing Group. Therapeutic Guidelines: Antibiotic. Version 13. Updated July 2009 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2006.
- Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2009.