How Do Otic Antibiotics/Corticosteroids Work?

Otic antibiotic/corticosteroid combinations are used to treat inflammation and bacterial infection in the ears. Antibiotics kill bacteria and control infection, while corticosteroids suppress the inflammatory response to infection and relieve symptoms such as pain, swelling and irritation.

Antibiotics work in different ways to kill bacteria and clear the infection. Some antibiotics damage the bacterial cell membrane, some prevent the bacteria from synthesizing proteins required for their growth and some inhibit gyrase, an enzyme essential for bacterial DNA replication, promoting DNA strand breakage and cell death.

The immune system reacts to infection with the release of inflammatory proteins (cytokines) that leak out of the tiny blood vessels (capillaries) in the ear to fight the infection. Corticosteroids suppress the immune response by inhibiting cytokine release and decreasing the capillary permeability, which prevents the cytokines from leaking out.

Antibiotic/corticosteroid drug formulations may have one or more antibiotics combined with corticosteroids. Corticosteroids may also be combined with anti-infectives such as alcohol or acetic acid. Some drug formulations contain substances that improve absorption into the ear tissue.

Antibiotic/corticosteroid drugs are effective against ear infections caused by bacteria that include:

• Staphylococcus aureus
• Streptococcus pneumoniae
• Pseudomonas aeruginosa
• Haemophilus influenzae
• Moraxella catarrhalis
• Enterobacter aerogenes
• Escherichia coli
• Klebsiella pneumoniae

Otic antibiotics/corticosteroids are solutions or suspensions that are administered into the ear canal. Otic antibiotics/corticosteroid combinations are used to treat the following ear conditions:

• Bacterial otitis externa: External ear bacterial infection
• Otitis media: Middle ear infection
• Otic inflammation: Ear inflammation with itching (pruritus)
• Acute otitis media with tympanostomy tubes: Acute middle ear infection or inflammation after tympanostomy tube placement, a procedure in which fluid is suctioned from the middle ear and a tiny tube is placed through the eardrum to drain the fluid and relieve pressure
• Superficial bacterial infections of the external auditory canal: Bacterial infection in the ear canal which extends from the ear opening to the eardrum
• Bacterial infections of mastoidectomy and fenestration cavities: Mastoidectomy is a procedure to remove infected tissue in the air-filled spaces within the mastoid bone located behind the ear. Fenestration is a surgical procedure to create an opening in the inner ear labyrinth to improve hearing.

Side effects of otic antibiotics/corticosteroids may include:

Otic side effects:

• Ear discharge (otorrhea)
• Excessive granulation, a stage of scar tissue formation
• Ear infection
• Ear itching (pruritus)
• Eardrum (tympanic membrane) disorder
• External ear (auricular) swelling
• Tingling in ears
• Ear discomfort
• Hearing loss
• Noises in the ear (tinnitus)
• Ear congestion
• Tympanostomy tube obstruction
• Ototoxicity
• Burning, irritation and dryness
• Inflammation of hair follicles (folliculitis)

Systemic side effects:

• Balance disorder
• Allergic reaction
• Fungal superinfection such as candidiasis
• Taste disorder (dysgeusia)
• Headache
• Migraine headache
• Dizziness
• Flushing
• Skin exfoliation
• Skin sensitization
• Nephrotoxicity (toxicity to the kidneys)
• Abnormal hair growth (hypertrichosis)
• Acne eruptions
• Loss of skin pigmentation
• Perioral dermatitis
• Allergic contact dermatitis
• Secondary infection
• Skin softening and breaking down (maceration)
• Skin damage (atrophy)
• Scarring of skin (striae)
• Prickly heat (miliaria)
• Hair loss (alopecia)
• Fungal dermatitis
• Hypersensitivity of the skin (hyperesthesia)
• Abnormal skin sensation (paresthesia)
• Hypersensitivity skin reactions such as:
  • Rash
  • Hives (urticaria)
  • Itching (pruritus)
  • Redness
  • Swelling
• Cough

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand name of otic antibiotic/corticosteroid drugs include:

• Ciprofloxacin hydrochloride/fluocinolone acetonide otic (Otovel)
• Colistin sulfate/hydrocortisone acetate/neomycin sulfate/thonzonium bromide (Coly-Mycin S)
• Dexamethasone/ciprofloxacin (Ciprodex)
• Hydrocortisone/alcohol otic (Earsol-HC)
• Hydrocortisone/ciprofloxacin hydrochloride (Cipro HC Otic)
• Hydrocortisone/neomycin/polymyxin otic
• Hydrocortisone/acetic acid glacial otic (Vosol HC)