Acute otitis media with tympanostomy tubes (AOMT) is a common condition in paediatric patients, often requiring effective and timely treatment to prevent complications. According to the RSA guidelines, topical ciprofloxacin/dexamethasone otic suspension (ciprofloxacin/dexamethasone) is the recommended choice for managing AOMT. 

Acute otitis media with tympanostomy tubes (AOMT) is a common condition in paediatric patients, often requiring effective and timely treatment to prevent complications. 

According to the RSA guidelines, topical ciprofloxacin/dexamethasone otic suspension (ciprofloxacin/dexamethasone) is the recommended choice for managing AOMT. This recommendation is supported by several studies highlighting its superior efficacy and safety profile compared to other treatments. 

Higher cure rates with ciprofloxacin/dexamethasone vs oral amoxicillin/
clavulanic acid  

A study by Dohar et al. compared the effectiveness of ciprofloxacin/dexamethasone with oral amoxicillin/clavulanic acid (AMOX/CLAV) in treating AOMT. The study involved 80 children aged six months to 12 years, who were randomly assigned to receive either ciprofloxacin/dexamethasone (four drops twice daily for seven days) or AMOX/CLAV
(600 mg every 12 hours for 10 days). The results were compelling:  

• The median time to cessation of otorrhoea was significantly shorter for the ciprofloxacin/dexamethasone group (four days) compared to the AMOX/CLAV group (seven days) 
• The clinical cure rate was higher in the ciprofloxacin/dexamethasone group, with 85% achieving clinical cure versus 59% in the AMOX/CLAV group 
• Adverse events were less frequent with ciprofloxacin/dexamethasone, with ear pain reported in 5.1% of cases, while AMOX/CLAV was associated with higher rates of diarrhoea (19.5%), dermatitis (7.3%), and gastroenteritis (4.9%). 

These findings support the use of ciprofloxacin/dexamethasone as a more effective and safer treatment option for AOMT compared to oral antibiotics.  

Ciprofloxacin/dexamethasone vs ofloxacin: Superior clinical and microbiological outcomes.  

Another study by Roland et al. evaluated the efficacy of ciprofloxacin/dexamethasone compared to ofloxacin in children with AOMT. This randomised trial included 599 participants aged six months to 12 years, who received either Ciprofloxacin/dexamethasone (four drops twice daily for seven days) or ofloxacin (five drops twice daily for 10 days). The key findings were:  

• Ciprofloxacin/dexamethasone achieved a clinical cure rate of 90% compared to 78% for ofloxacin 
• The microbiologic success rate was 92% for ciprofloxacin/dexamethasone versus 81.8% for ofloxacin 
• Treatment failures were lower in the ciprofloxacin/dexamethasone group
  (4.4% vs 14.1%). 

The median time to cessation of otorrhoea was shorter for ciprofloxacin/dexamethasone (four days) compared to ofloxacin (six days). These results demonstrate that ciprofloxacin/dexamethasone is not only more effective in achieving clinical and microbiological cure but also provides quicker symptom resolution compared to ofloxacin.  

Conclusion  

The evidence from these studies underscores the efficacy and safety of ciprofloxacin/dexamethasone in treating AOMT. With higher cure rates, quicker resolution of symptoms, and fewer adverse effects, Ciprofloxacin/dexamethasone stands out as the preferred treatment option.  

The RSA guidelines rightly recommend ciprofloxacin/dexamethasone for managing AOMT, ensuring better outcomes for paediatric patients. 

References available on request.