# Ear discharge (otorrhoea)

- Category: infectious
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · No dose - assessment step, no medicine given · Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK556055; PMID: 32310515.
- Verified date: 2026-08

## Verified against

- Egyptian National Drug Formulary - Antimicrobial 2023
- No dose - assessment step, no medicine given
- Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK556055; PMID: 32310515.

## Treatment metadata

- Ciprofloxacin — ear
- No drug therapy in primary care (Assess first)

## Complete treatment card

```text
EAR DISCHARGE (OTORRHOEA)
Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · No dose - assessment step, no
         medicine given · Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2023 Jul 31]. In:
         StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf
         ID: NBK556055; PMID: 32310515.
Review status: REVIEWED against 3 sources listed above  (2026-08)

1. CIPROFLOXACIN                                          [1st line]
   Adult    Instill 3-4 drops into affected ear twice daily x 7 days
   Peds     Over 1 year: 3 drops twice daily into affected ear for 7 days
            (Children >1 year: 3 drops twice daily into affected ear for 7 days)
   AWaRe    WATCH group - carries resistance cost. Egyptian EML 2025.
   Source   Egyptian National Drug Formulary - Antimicrobial 2023
   Why      A discharging ear means the eardrum is perforated until proved otherwise, so the drop
            has to be safe behind a perforation. Ciprofloxacin is non-ototoxic and covers the
            Pseudomonas and staphylococci that cause it. That safety, not the spectrum, is the
            reason it is first choice.
   Caution  Do NOT use aminoglycoside ear drops - gentamicin, neomycin, framycetin - when the drum
            may be perforated. They can cause permanent, irreversible deafness, and a discharging
            ear is a perforated ear until you have seen otherwise.
            Clean debris from ear canal prior to instillation.
            Keep ear canal dry during treatment.
            Foul-smelling discharge, a retraction pocket, or granulation tissue at the drum edge
            suggests cholesteatoma. That is a surgical problem - refer to ENT rather than repeating
            drops.
            Discharge with facial weakness, vertigo, severe pain, or swelling and tenderness behind
            the ear is mastoiditis or an intracranial complication - same-day referral.
            Discharge that will not stop after two proper courses, or that returns as soon as
            treatment ends, needs ENT assessment and a swab.
            Egypt also registers OTOXIN 3 mg/mL ofloxacin ear drops (11 EGP), equally non-ototoxic
            and a reasonable alternative. It is not listed as its own option because no dosing label
            for it could be opened, and no dose is shown here that cannot be cited.
            Ciprofloxacin is safe with a perforated tympanic membrane (non-ototoxic).
   Egypt    CIPRO 0.3% EAR DROPS 10 ML       CID                 15.00 EGP

2. NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST)         [1st line]
   Adult    Before treating, work out where the discharge is coming from. Otitis externa gives a
            tender, swollen, itchy canal and pain on pulling the pinna. Discharge through a
            perforation or a grommet comes from the middle ear and often follows an acute otitis
            media that has just burst, with the pain suddenly relieved. Wax, a foreign body and
            blood after trauma are the other things in the canal. - Assess, then decide
   Peds     A unilateral foul discharge in a child with no pain is a foreign body in the canal until
            proved otherwise - look. Discharge through a grommet is common and is usually treated
            with the same quinolone drop.
   Source   No dose - assessment step, no medicine given
   Why      The choice of drop and the decision to refer both hang on whether the drum is intact,
            and that single question is what makes the difference between a safe drop and a
            deafening one.
   Caution  Blood or clear fluid from the ear after a head injury may be cerebrospinal fluid. Do not
            instil anything - refer immediately.
            In a diabetic or immunocompromised patient with severe pain, granulation in the canal
            floor and discharge, consider necrotising (malignant) otitis externa. That is an
            emergency admission, not a drop.
            Syringing an ear that is discharging, or that may be perforated, is not safe.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

---

Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement.

[Privacy policy](/privacy)