For otitis externa where the tympanic membrane cannot be visualized due to cerumen, what is the most appropriate antibiotic ear drop regimen?

• A. Neomycin / PolymyxinB / hydrocortisone drops
• B. Ciprofloxacin / Dexamethasone drops
• C. Oral Ciprofloxacin
• D. Oral Cefepime

Answer: (B)

When the tympanic membrane cannot be visualized because of cerumen, you need a topical antibiotic that is effective against common external ear pathogens and safe even if the membrane might be perforated. A ciprofloxacin-based otic drop with dexamethasone fits this scenario: it provides targeted coverage against Pseudomonas aeruginosa and Staphylococcus aureus and the steroid helps reduce inflammation and edema, improving drainage and comfort. Avoid drops containing aminoglycosides like neomycin in this setting because they can be ototoxic if the tympanic membrane is perforated. Oral antibiotics are not first-line for uncomplicated otitis externa and are reserved for more severe or invasive disease (such as malignant otitis externa) or systemic symptoms. Therefore, topical ciprofloxacin with dexamethasone is the best choice here.