Ear Therapy

Ototopical Advantages:

In treating ear infections with antibiotics, topical delivery has a number of advantages over systemic delivery. These advantages include the following:

  • A vastly higher concentration of antibiotic can be delivered to the site of infection
  • Medications delivered topically have no systemic effects
  • Topical delivery allows alteration of the local microenvironment
  • Ototopical medications are usually less expensive than comparable systemic medications


Otic Powder:

CSF Otic Powder is a simple, effective method for dry-powder treatment in managing chronic otitis media and otitis externa. Powders are able to adhere to moist surfaces and have a longer dwelling time than liquid preparations.

CSF Powder includes two antibiotics: chloramphenicol and sulfamethoxazole/Trimethoprim, and the antifungal (fungizone) amphotericin B. CSF-HC contains the same active ingredients as CSF, but also includes hydrocortisone to reduce inflammation.

CSF Powder #2 includes two antibiotics: Ciprofloxacin and sulfacetamide, and the antifungal (fungizone) amphotericin B. CSF-HC contains the same active ingredients as CSF, but also includes hydrocortisone to reduce inflammation.


CSF Otic Powder Delivery Devices

Solutions Rx Pharmacy has available two different insufflator devices to deliver CSF powder to the ear cavity:

Sheehy-House Powder Insufflator:

This is used with CSF powder in #4 capsules. Each capsule will normally last between 10-15 puffs. Capsules should be refrigerated, except for the one stored in the insufflator.

Accordion Insufflator:

Includes 3 grams of CSF powder per disposable accordion. Insufflator normally lasts around 80 puffs and should be refrigerated between use. The accordion insufflator is included in the price of the prescription.


Ototopical Solutions

Commonly Requested Formulations:

Amphotericin-B 0.25% Otic Solution

Ciprofloxacin 1.164%/Ketoconazole 1% Otic Solution

Lidocaine HCl 4%/Phenylephrine 0.25% Otic Solution

Mupirocin 1% Otic Solution

Tobramycin Sulfate 1% Otic Solution

Vancomycin 16.67mg/ml or 25mg/ml Otic Solution


How to use the Insufflator Bulb with your Compounded Otic Gel Caps


Our pharmacy  compounds otic gel caps containing antibiotics (anti-bacterial as well as anti-fungal) and even steroids (usually hydrocortisone) as ordered by your physician. During an active infection, the powder is “puffed” into the ear twice a day. Once back to normal, one puff weekly prevents the ear from becoming infected again. This method eliminates adding more “moisture” to the ear (as when happens when using antibiotic ear drops) as the powder not only addresses the infection, but the drainage itself becomes a medium for the antibiotic powder to do its thing.

Below are the instructions on how to properly load the otic capsule into the insuufflator  bulb:

First remove the tip of the insufflator bulb

Then open up the gel cap such that the powder is all in one side of the capsule. The capsule has 2 parts: a short end and a long end. With the short end facing up, gently tap on a hard surface to let the powder fall into the long end of the capsule. Remove the top (shorter end) so that the open end is facing up and the powder is in the lower portion of the capsule.  Now insert the open end of the capsule into the insufflator tip compartment, while the bulb is on top. By keeping the bulb end up, it will prevent the powder from spilling into the bulb.

Then replace the bulb tip. Store the insufflator bulb always with the grey bulb facing up.


Store unused capsules in the refrigerator until time of administration. It is not necessary to refrigerate insufflator with capsule.