Potential Ototopical Antiseptics for the Treatment of Active Chronic Otitis Media: An In Vitro Evaluation

Abstract

Objectives: Primary: to compare, in vitro, the antimicrobial activity of different antiseptic agents versus quinolone drops, against the common organisms of chronic otitis media. Secondary: to examine the possible role of pH on the antimicrobial activity of the antiseptic solutions. Methods: Three antiseptic powders (boric acid; iodine; and a 1:1 combination of these two) and four solutions (2% boric acid; 2% acetic acid; 3.25% aluminum acetate; and 5% povidone iodine) were tested against five bacteria and two fungi common in chronic otitis media, using both agar plates and the modified broth dilution method. These results were compared with the antimicrobial activity of quinolone drops. The potential role of pH of solutions was tested by reducing the acidity of the agents and repeating the broth dilution. Results: Of the powders, iodine, and iodine/boric acid combined, are very effective against all organisms. Boric acid powder showed moderate effectiveness against all organisms. All solutions performed poorly on the agar plates. 5% povidone iodine has good effectivity when tested with the broth dilution method. 3.25% aluminum acetate had the best activity against Pseudomonas aeruginosa. Conclusion: Boric acid powder and 5% povidone iodine solution show promise for clinical use. Boric acid powder has proven clinical effectiveness. 5% povidone iodine requires further clinical research. Although very effective in vitro, iodine powder is toxic to tissues and cannot be recommended for clinical use. The pH of solutions does not seem to play a significant role in their antimicrobial activity in vitro.

Efficacy of boric acid therapy in a pseudomonas aeruginosa-induced chronic otitis media model in rats

“…Otitis media (OM), one of the most common infectious diseases, particularly in developing countries, is caused by bacterial or viral pathogens in the middle ear 1,2 . The prevalence in different regions and ethnic groups can range between 0.4% and 46%, and it can be seen in all age groups 3,4 . Chronic OM (COM) is characterized by a perforated tympanic membrane, a persistent discharge from the middle ear, and hearing loss 1,5 .…”

“…Due to its mildly acidic nature, the outer ear canal is bacteriostatic in character. Lowering pH in COM may be beneficial to treatment by enhancing this bacteriostatic character 3 . The advantages of topical applications in otology include high concentrations being achieved in the area of application, the fact that no side-effects are caused, and lower bacterial resistance.…”