Treatment of Malignant External Otitis Systemic antibiotics, typically a fluoroquinolone and / or an aminoglycoside / semisynthetic penicillin combination Topical antibiotic / corticosteroid preparations (eg, ciprofloxacin / dexamethasone) Rarely, surgical debridement Treatment of malignant external otitis is typically with a 6-week IV course of a culture-directed fluoroquinolone (eg, ciprofloxacin, 400 mg IV every 8 hours) and / or a semisynthetic penicillin (piperacillin-tazobactam or piperacillin) / aminoglycoside combination (for ciprofloxacin resistant Pseudomonas).