A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa

Roland, Peter S.; Belcher, Barbara P.; Bettis, Robert; Makabale, Reynaldo L.; Conroy, Peter J.; Wall, G. Michael; Dupre, Sheryl J.; Potts, Susan L.; Hogg, Gail; Weber, Kaye R.

doi:10.1016/j.amjoto.2007.09.002

Cited by 33 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After three reviewers came to a consensus concerning further eliminations, six and eight studies, respectively, were available for this systematic review (Table 1). 12–19…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of acute otitis externa with ciprofloxacin otic 0.2% antibiotic ear solution

Mösges¹,

Nematian-Samani²,

Eichel³

2011

TCRM

View full text Add to dashboard Cite

Background/objectiveAn inflammation of the cutis and subcutis of the external auditory canal is a primary symptom in cases of acute otitis externa. It is usually treated locally, since this type of therapy ensures a high concentration of the drug and interacts at the site of inflammation with no systemic effects. This systematic review compares the efficacy of treatment using a ciprofloxacin 0.2% solution with other therapeutic options.MethodsAfter compiling a catalog of search terms, medical databases were searched systematically for randomized, controlled studies. This search initially yielded a total of 38 studies which were then evaluated by three independent reviewers. The number of studies was subsequently reduced to 14: six studies using a ciprofloxacin 0.2% solution, and eight studies using both 0.2% and 0.3% solutions.ResultsThe studies included in the review demonstrate the statistical equivalence between the ciprofloxacin solution (0.2%) and the reference products PNH (a combination of polymyxin B, neomycin sulfate and hydrocortisone), auriculum powder, and a ciprofloxacin foam with respect to the cure rate. The research groups consistently observed high in vitro activity of ciprofloxacin against Pseudomonas aeruginosa.ConclusionThis systematic review confirms the hypothesis of ciprofloxacin’s noninferiority in the treatment of otitis externa, in terms of the cure rate and microbiological eradication.

show abstract

“…After three reviewers came to a consensus concerning further eliminations, six and eight studies, respectively, were available for this systematic review (Table 1). 12–19…”

Section: Resultsmentioning

confidence: 99%

“…Time to end of pain constituted a relevant target value for three of the studies included:15,17,19 Pistorius et al17 determined this parameter via the Visual Analog Scale; Lildholdt et al15 and Roland et al19 rated pain perception in diary entries on a scale of 0–4.…”

Section: Background (Included Studies)mentioning

confidence: 99%

Treatment of acute otitis externa with ciprofloxacin otic 0.2% antibiotic ear solution

Mösges¹,

Nematian-Samani²,

Eichel³

2011

TCRM

View full text Add to dashboard Cite

show abstract

“…Another randomized multicenter trial showed no differences in pain duration or bacteriologic efficacy between topical ciprofloxacin/hydrocortisone (Cipro HC) and combination therapy with oral amoxicillin and topical neomycin/polymyxin b/hydrocortisone. 114 An argument against the use of oral antibiotics for diffuse AOE limited to the ear canal is the efficacy of topical treatments that do not include antibiotics. Effective topical treatments include acetic acid, 100 118,119 and an endogenous antiseptic N-chlorotaurine.…”

Section: Lack Of Efficacy Of Systemic Antibiotic Therapymentioning

confidence: 99%

Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

Self Cite

134

View full text Add to dashboard Cite

Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

show abstract

“…6,7 Furthermore, ototopical fluroquinolones as monotherapy have been shown to be as efficacious as the combination of topical and oral antibiotic treatment in otitis externa, with less propensity for resistance and adverse medication reactions. 8 Of note, cost is often less with ototopical monotherapy.…”

Section: Treatmentmentioning

confidence: 99%