Ciprofloxacin and Dexamethasone (Otic)

Designed to treat inner and outer bacterial ear infections, ciprofloxacin and dexamethasone is an otic suspension which is administered directly into the ear via drops.

Overview

Ciprofloxacin and dexamethasone is an otic suspension designed to treat infections in the ear canal (otis externa) and inside the ear (otis media). The medicine is administered in ear drop form and should be applied directly into the ear.

Ciprofloxacin is an antibiotic, and treats infection by attacking the bacteria which has caused it. Dexamethasone is a steroid and works to reduce inflammation by suppressing the immune system and reducing the actions of chemicals in the body which cause an inflammatory response. Inflammation commonly occurs during infection as the body reacts to offending bacteria in an attempt to fight it off. However, inflammation tends to cause pain and discomfort, so by including the steroid dexamethasone in the ear drops, it is possible to reduce pain, itching and discomfort while the antibiotics get to work clearing the infection.

Ciprofloxacin and dexamethasone is only suitable for bacterial ear infections. It should not be used to treat viral infections of the ear canal, such as chickenpox or herpes, or fungal ear infections.

In the US, ciprofloxacin and dexamethasone is available only with a doctor's prescription and is known under the brand name Ciprodex.

Condition(s) treated?

  • Bacterial inner and outer ear infections

Type of medicine?

  • Antibiotic
  • Steroid anti-inflammatory

Side Effects

Ciprofloxacin and dexamethasone can, in rare instances, cause side effects which are serious and require urgent medical attention. If you notice any of the following side effects when using this drug, contact your doctor immediately:

  • Severe burning or irritation in ear after using the drops
  • Abnormal drainage from ear
  • Cough
  • Trouble swallowing
  • Chest tightness
  • Dizziness
  • Hives, itching or rash
  • Hive-like swellings on eyelids, lips, tongue, face, throat, hands, legs, feet or genitals
  • Puffy or swollen eyes, face, lips or tongue
  • Abnormal weakness or tiredness
  • Abnormal heartbeat
  • Rapid heart rate

There are also side effects associated with ciprofloxacin and dexamethasone that are relatively minor and don't usually require medical attention. Sometimes they dissipate as your body adjusts to the medicine or as the infection starts to clear. If they become very severe and bothersome, you could consult your doctor. The following are examples of such side effects:

  • Ear pain or discomfort
  • Ear congestion
  • Ear debris
  • Ear residue
  • Itchy skin on the ear
  • Redness of skin on the ear
  • Superimposed (second) ear infection
  • Bitter, sour taste in the mouth

If you notice any other side effects not listed here, tell your doctor about them as soon as possible. You could also report side effects to the FDA.

Dosage

The dosing information provided here outlines average or recommended dosages. Your dosage may vary depending on your medical history and the severity of your ear infection. Always follow your doctor's directions. You should not apply the ear drops more frequently or for longer than directed, as doing so could increase the risk of side effects.

Dosing for middle ear infections and outer ear infections:

Adults and children aged 6 months and older:

  • 4 drops in the affected ear(s) twice each day
  •  7 days total treatment

Children under 6 months:

  • Use and dose determined by doctor

It is important to finish the full course of ciprofloxacin and dexamethasone drops as prescribed by your doctor, even if you feel that your ear infection has improved sooner. The infection may not completely go away if you do not complete the full course and symptoms could return at a later point.

How to use ciprofloxacin and dexamethasone ear drops

Ciprofloxacin and dexamethasone should be provided with a patient information leaflet. You should read this thoroughly as it contains instructions on how to correctly administer the ear drops.

Before you use ciprofloxacin and dexamethasone ear drops, wash your hands thoroughly to avoid introducing more bacteria into the ear. Hold the medicine bottle in your hands for a few minutes to warm the suspension inside. This will help to prevent dizziness which could occur when applying cold drops to the ear. The bottle should also be thoroughly shaken before use.

Lie down on your side with the affected ear facing up. Apply the prescribed number of drops to the ear, taking care to avoid touching the applicator to any surface, including the ear itself. This will help to keep the medicine free from bacteria. It may be helpful to have someone else apply the drops for you so that they can gently pull the outer ear lobe up and back to allow the drops to flow down into the ear canal. You should then remain in the same position for 60 seconds so that the drops are fully absorbed into the ear.

If the drops have been prescribed to treat a middle ear infection in someone with a tube, it is usually necessary to have someone else administer the ear drops. Once the drops have been applied to the ear, the small projection on the outside opening of the ear should be gently pumped 5 times. This helps the drops pass through the tube and into the inner ear.

If you are treating infection in both ears, simply repeat the steps outlined above for the second ear. Make sure you wait 60 seconds after applying the drops before turning over to treat the other ear.

Always firmly replace the lid of the ear drops after each application to minimize the risk of it being contaminated between uses. Once the course of therapy is complete, unused medicine should be disposed of.

Only use this medicine in the ears. Do not apply in the eyes, nose or mouth. If it does come into contact with these areas, call your doctor straight away.

Infected ears should be kept clean and dry to ensure the infection isn't worsened and to give the medicine the best chance of working. Keep the ear dry when bathing or showering, and avoid swimming. Only disregard these instructions if your doctor has advised otherwise.

Missed doses

If you miss a dose of ciprofloxacin and dexamethasone, take it as soon as you remember. However, if when you remember it is almost time for the next dose, simply skip the missed dose and take the next one at the usual time. Do not double doses to make up for a missed dose, as this could increase the risk of side effects.

It is incredibly important that you try to avoid missing doses as doing so could prevent the medicine from properly clearing the infection. Set alarms throughout the day to remind you to apply each dose.

Interactions

Some medicines can interact with ciprofloxacin and dexamethasone and cause unwanted effects, such as:

  • Increased risk of side effects
  • Risk of other health complications
  • Reduced efficiency of one or both medications

It is very important that your doctor knows about all the medicines you currently take. This includes those prescribed to you and those purchased over the counter, as well as herbal supplements, vitamins and multivitamins. They may choose to prescribe alternative treatments to ciprofloxacin and dexamethasone, or they may change or adjust the dosages of medicines you currently take.

The following medicines should never be taken at the same time as ciprofloxacin and dexamethasone:

  • Agomelatine
  • Amifampridine (Firdapse)
  • Amisulpride
  • Artemether (Coartem)
  • Bepridil (Vascor)
  • Cisapride (Propulsid)
  • Dronedarone (Multaq)
  • Flibanserin (Addyi)
  • Mesoridazine (Serentil)
  • Pimozide (Orap)
  • Piperaquine
  • Praziquantel (Biltricide)
  • Rilpivirine (Edurant)
  • Rotavirus Vaccine, Live (Rotarix, RotaTeq, RotaShield)
  • Saquinavir (Invirase, Fortovase)
  • Sparfloxacin (Zagam)
  • Terfenadine (Seldane)
  • Thioridazine (Mellaril, Mellaril-S)
  • Tizanidine (Zanaflex)
  • Ziprasidone (Geodon)

Interactions with other medical problems

People with fungal ear infections in the outer ear or viral ear infections (such as herpes simplex virus or chicken pox virus) should not use ciprofloxacin and dexamethasone. Doing so could worsen these types of infections. Make sure your doctor has your full medical history so that they can assess whether ciprofloxacin and dexamethasone is the right treatment for you.

Warnings

Severe ear pain and hearing problems

Ciprofloxacin and dexamethasone may not be suitable for patients with very severe ear pain or hearing problems. Make sure your doctor knows about all your symptoms and the severity of your symptoms so that they can assess whether it is a safe and suitable treatment for you. Although ear infections can cause pain and discomfort, very severe ear pain could be a sign of other problems which might be worsened by ear drops or antibiotics.

Risk of allergic reaction

Ciprofloxacin and dexamethasone can cause life-threatening anaphylaxis. Seek emergency medical care if you experience any of the following signs of anaphylaxis:

  • Rash
  • Itching
  • Difficulty breathing
  • Difficulty swallowing
  • Swelling of face, mouth, throat or hands

If you have ever suffered an allergic reaction to any type of antibiotic before, make sure your doctor knows before you start taking ciprofloxacin and dexamethasone. This is particularly important if the reaction was to an antibiotic similar to ciprofloxacin, such as:

  • moxifloxacin (Avelox)
  • ofloxacin (Floxin)
  • levofloxacin (Levaquin)
  • lomefloxacin (Maxaquin)
  • norfloxacin (Noroxin)
  • gatifloxacin (Tequin)

You should also make sure your doctor is aware of other allergies you might have, including food, dyes, preservatives, chemicals or animals. They will able to decide if any of the ingredients in ciprofloxacin and dexamethasone could pose a risk to you.

Continued or worsening symptoms

If after your course of ciprofloxacin and dexamethasone has finished you still experience signs of infection, or if symptoms get worse, check with your doctor. They may advise you to continue with the treatment for longer, or they may try a different treatment.

If you experience two or more bacterial ear infections within six months, your doctor may administer further tests. Sometimes multiple ear infections can be a sign of other underlying medical conditions, such as cholesteatoma (noncancerous skin growth behind the eardrum), tumor, or foreign body in the ear.

Otorrhea after the course has finished

Otorrhea is the medical term for ear drainage. You may experience this throughout the treatment process as the infection clears. However, if you continue to see fluid draining from the ear after the course of ciprofloxacin and dexamethasone is finished, tell your doctor. It may be a sign that the infection is still present or that there are other complications that need treatment.

Pediatric use

Ciprofloxacin and dexamethasone has been studied and deemed safe and effective in children over the age of six months. However, in infants under 6 months, there have not been enough studies performed to establish safety and efficacy. In some instances, the medicine may still be prescribed if a doctor deems it an appropriate treatment.

Pregnancy and breastfeeding

Animal studies have found that ciprofloxacin could cause weight loss and gastrointestinal problems in the mother. They have also demonstrated that corticosteroids like dexamethasone could affect fetal development. There is no evidence available on the effects of ciprofloxacin and dexamethasone during human pregnancy. However, due to the evidence from the animal studies, the FDA has marked ciprofloxacin and dexamethasone as a pregnancy category C drug, which means it poses a potential risk to pregnant women. The drug should, therefore, be avoided during pregnancy unless the benefits of the drug far outweigh the potential risks to the fetus.

It is not known whether ciprofloxacin and dexamethasone is excreted in human breast milk when administered via ear drops. However, we do know that both ciprofloxacin and dexamethasone are excreted in breast milk when administered orally. Dexamethasone could cause suppressed growth and other harmful effects in breastfeeding infants when the mother takes it orally. For this reason, the use of ciprofloxacin and dexamethasone otic is not recommended during breastfeeding. If the drug is very important to the health a breastfeeding mother, they may choose to stop breastfeeding in order that they can use the medicine.

Storage

Ciprofloxacin and dexamethasone should be stored in the container it is provided in at room temperature. It should be kept from freezing and away from heat, direct light and moisture. It's important to warm the medicine bottle in your hands for a couple of minutes before applying the drops to ensure they are at body temperature. This will prevent dizziness.

Make sure you avoid touching the tip of the dropper when using it, as this will prevent contamination of the medicine. You should also screw the lid on tightly when you finish applying each dose to minimize the risk of it becoming contaminated with harmful bacteria.

Once you have finished your course of ciprofloxacin and dexamethasone, do not hold onto the drops. Instead, dispose of them according to your healthcare providers instructions.

Always keep ciprofloxacin and dexamethasone out of reach of children and pets. It could be harmful if swallowed or if it comes into contact with the eyes, nose or mouth. You should make sure the medicine is stored up and away from the ground so that it is not within easy reach of children and pets.

Never share ciprofloxacin and dexamethasone drops with other people. This is a prescribed medicine and could be harmful if used by persons it is not prescribed to. Furthermore, sharing ear drops poses the risk of spreading infection from one person to another.

Summary

Ciprofloxacin and dexamethasone is a combination drug designed to treat bacterial infections of the middle ear and outer ear. It is not suitable for fungal or viral infections. It is administered in an otic suspension in order that it can be applied directly inside the ear in the form of drops. In the US it is sold under the brand name Ciprodex and it is only available with a doctor's prescription.

Ciprofloxacin is an antibiotic. It works by destroying bacteria and inhibiting further growth of bacteria to eliminate infection. Dexamethasone is a corticosteroid and has anti-inflammatory effects. It works by suppressing the immune system to inhibit chemical processes which cause inflammation. Inflammation often occurs when infection is present in the body, and by reducing it with corticosteroids patients will experience relief from pain, itching and discomfort.

In rare instances ciprofloxacin and dexamethasone can cause serious side effects such as severe burning or irritation of the ear, abnormal ear drainage, dizziness, and allergic reaction (such as swelling of face and mouth, rash and troubled breathing). These effects should be reported to a doctor immediately. Minor side effects associated with the drug are mild ear pain or discomfort, ear debris or congestion, itchiness or redness of the skin on the ear, and a bitter taste in the mouth. These side effects usually do not require treatment by a doctor.

The usual recommended dosage of ciprofloxacin and dexamethasone is four drops administered twice each day for a total of seven days. It is very important to adhere to the dosing schedule and to complete the full course. Failure to do so could mean that the infection doesn't fully clear and gets worse at a later date. Always finish the course even if you feel better before the 7 days are finished.

To use ciprofloxacin and dexamethasone drops, lay on your side with the infected ear facing upwards. Apply the drops into the ear without allowing the dropper to touch the ear itself. Wait for 60 seconds in this position. If you are treating both ears, you can then turn over and repeat the process on the second ear. Individuals with middle ear infections who have tubes may need to gently pump the protruding part of the tube to ensure the drops travel completely down the tube.

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Last Reviewed:
December 22, 2017
Last Updated:
April 05, 2018
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