Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T15:02:44.307Z Has data issue: false hasContentIssue false

Ciprofloxacin plus fluocinolone acetonide versus ciprofloxacin alone in the treatment of diffuse otitis externa

Published online by Cambridge University Press:  07 July 2014

J Lorente*
Affiliation:
Servicio de Otorrinolaringología (ORL), Hospital Vall d'Hebron, Barcelona, Spain
F Sabater
Affiliation:
Servicio ORL, Hospital Clínic i Provincial, Barcelona, Spain
M P Rivas
Affiliation:
Servicio ORL, Hospital de Viladecans, Spain
J Fuste
Affiliation:
CAP Poble Nou, Barcelona, Spain
J Risco
Affiliation:
Servicio ORL, Hospital Universitari Juan XXIII, Tarragona, Spain
M Gómez
Affiliation:
Servicio ORL, Hospital de Poniente, El Ejido, Almería, Spain
*
Address for correspondence: Dr Juan Lorente Guerrero, Servicio ORL, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119–129, 08035 Barcelona, Spain E-mail: [email protected]

Abstract

Objective:

We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa.

Methods:

This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7 years or older.

Results:

The rate of clinical cure was higher (p = 0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p = 0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p = 0.003 and p = 0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p = 0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment).

Conclusions:

Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1García Rodríguez, JA, García Sánchez, JE, García García, MI, García Sánchez, E, Muñoz Bellido, JL, Ramos Macías, A. Efficacy of topical ciprofloxacin in the treatment of ear infections in adults. J Antimicrob Chemother 1993;31:452–3Google Scholar
2Podoshin, L, Fradis, M, Ben David, J. Ototoxicity of ear drops in patients suffering from chronic otitis media. J Laryngol Otol 1989;103:4650CrossRefGoogle ScholarPubMed
3Parker, FL, James, GW. The effect of various topical antibiotic and antibacterial agents on the middle and inner ear of the guinea-pig. J Pharm Pharmacol 1978;30:236–9Google Scholar
4Johnsson, LG, Hawkins, JE Jr, Kingsley, TC, Black, FO, Matz, GJ. Aminoglycoside-induced cochlear pathology in man. Acta Otolaryngol Suppl 1981;383:119Google Scholar
5Browning, GG, Gatehouse, S, Calder, IT. Medical management of active chronic otitis media: a controlled trial. J Laryngol Otol 1988;102:491–5Google Scholar
6Baker, RS, Chole, RA. A randomized clinical trial of topical gentamicin after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 1988;114:755–7CrossRefGoogle ScholarPubMed
7Clayton, MI, Osborne, JE, Rutherford, D, Rivron, RP. A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in the treatment of otorrhoea. Clin Otolaryngol Allied Sci 1990;15:710CrossRefGoogle ScholarPubMed
8Ganz, H. Clinical efficacy of ciprofloxacin in otorhinolaryngological infections. In: Neu, HC, Weuta, H, eds. First International Ciprofloxacin Workshop. Leverkusen, 6–8 November 1985. Current Clinical Practice Series. Amsterdam: Excerpta Medica, 1986;395–6Google Scholar
9Piccirillo, JF, Parnes, SM. Ciprofloxacin for the treatment of chronic ear disease. Laryngoscope 1989;99:510–3Google Scholar
10Falser, N, Mittermayer, H, Weuta, H. Antibacterial treatment of otitis and sinusitis with ciprofloxacin and penicillin V: a comparison. Infection 1988;16(suppl 1):51–4Google Scholar
11Falser, N. Clinical efficacy of ciprofloxacin in ear, nose and throat infections: preliminary results. In: Neu, HC, Weuta, H, eds. First International Ciprofloxacin Workshop. Leverkusen, 6–8 November 1985. Current Clinical Practice Series. Amsterdam: Excerpta Medica, 1986;397–8Google Scholar
12Federspil, P. Clinical efficacy of ciprofloxacin in ear, nose and throat infections. In: Neu, HC, Weuta, H, eds. First International Ciprofloxacin Workshop. Leverkusen, 6–8 November 1985. Current Clinical Practice Series. Amsterdam: Excerpta Medica, 1986;399401Google Scholar
13Van de Heyning, PH, Pattyn, SR, Valcke, HD, Van Caeckenberghe, DL, Jans, HW, Boerema, JBJ et al. Use of ciprofloxacin in chronic suppurative otitis. Rev Infect Dis 1988;10(suppl 1):250–1Google Scholar
14Van de Heyning, PH, Pattyn, SR, Valcke, HD. Ciprofloxacin in oral treatment of ear infections. Pharm Weekbl Sci 1986;8:63–6Google Scholar
15Dumas, G, Bessard, G, Gavend, M, Charachon, R. Risk of deafness following ototopical administration of aminoglycoside antibiotic [in French]. Thérapie 1980;35:357–63Google Scholar
16Papastavros, T, Giamarellou, H, Varlejides, S. Role of aerobic and anaerobic microorganisms in chronic suppurative otitis media. Laryngoscope 1986;96:438–42Google Scholar
17Karma, P, Jokippi, L, Ojala, K, Jokipii, AM. Bacteriology of the chronically discharging middle ear. Acta Otolaryngol 1978;86:110–14CrossRefGoogle ScholarPubMed
18Brook, I, Finegold, SM. Bacteriology of chronic otitis media. JAMA 1979;241:487–8Google Scholar
19Claes, J, Govaerts, PJ, Van de Heyning, PH, Peeters, S. Lack of ciprofloxacin ototoxicity after repeated ototopical application. Antimicrob Agents Chemother 1991;35:1014–16Google Scholar
20Bagger-Sjöbäck, D, Lundman, L, Nilsson-Ehle, I. Ciprofloxacin and the inner ear: a morphological and round window membrane permeability study. ORL J Otorhinolaryngol Relat Spec 1992;54:59CrossRefGoogle ScholarPubMed
21Brownlee, RE, Hulka, GF, Prazma, J, Pillsbury, HC 3rd. Ciprofloxacin. Use as a topical otic preparation. Acta Otolaryngol Head Neck Surg 1992;118:392–6Google ScholarPubMed
22Bagger-Sjöbäck, D, Spångberg, ML. Does ciprofloxacin affect inner ear? A preliminary report. Scand J Infect Dis Suppl 1989;60:2834Google Scholar
23Esposito, S, D'Errico, G, Montanaro, C. Topical and oral treatment of chronic otitis media with ciprofloxacin. A preliminary study. Arch Otolaryngol Head Neck Surg 1990;116:557–9Google Scholar
24Esposito, S, Noviello, S, D'Errico, G, Montanaro, C. Topical ciprofloxacin vs intramuscular gentamicin for chronic otitis media. Arch Otolaryngol Head Neck Surg 1992;118:842–4Google Scholar
25Lorente, J, Sabater, F, Maristany, M, Jiménez, R, Menem, J, Viñas, J et al. Multicenter study comparing the efficacy and tolerability of topical ciprofloxacin (0.3%) versus topical gentamicin (0.3%) in the treatment of simple, non-cholesteatomatous chronic otitis media in the suppurative phase [in Spanish]. An Otorrinolaringol Ibero Am 1995;5:521–33Google Scholar
26Sabater, F, Maristany, M, Mensa, J, Villar, E, Traserra, J. Prospective double-blind randomized study of the efficacy and tolerance of topical ciprofloxacin vs topical gentamicin in the treatment of simple chronic otitis media and diffuse external otitis [in Spanish]. Acta Otorrinolaringol Esp 1996;47:217–20Google Scholar
27Force, RW, Hart, MC, Plummer, SA, Powell, DA, Nahata, MC. Topical ciprofloxacin for otorrhea after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 1995;121:880–4Google Scholar
28Center for Drug Evaluation and Research. New Drug Application 20-805. In: http://www.accessdata.fda.gov/drugsatfda_docs/nda/98/20805-mr.pdf [3 June 2014]Google Scholar
29European Medicines Agency. ICH topic E 6 (R1). Guideline for Good Clinical Practice. In: http://ethikkommission.meduniwien.ac.at/fileadmin/ethik/media/dokumente/rechtsgrundlagen/GCP.pdf [3 June 2014]Google Scholar
30Dibb, WL. Microbial aetiology of otitis externa. J Infect 1991;22:233–9CrossRefGoogle ScholarPubMed
31Arnes, E, Dibb, WL. Otitis externa: clinical comparison of local ciprofloxacin versus local oxytetracycline, polymyxin B, hydrocortisone combination treatment. Curr Med Res Opin 1993;13:182–6Google Scholar
32Ganz, H. Local antibiotic therapy of bacterial ear infections [in German]. HNO 1989;37:386–8Google Scholar
33Kasemsuwan, L, Clongsuesuek, P. A double blind, prospective trial of topical ciprofloxacin versus normal saline solution in the treatment of otorrhoea. Clin Otolaryngol Allied Sci 1997;22:44–6Google Scholar
34Dohar, JE, Roland, P, Wall, GM, McLean, C, Stroman, DW. Differences in bacteriologic treatment failures in acute otitis externa between ciprofloxacin/dexamethasone and neomycin/polymyxin B/hydrocortisone: results of a combined analysis. Curr Med Res Opin 2009;25:287–91Google Scholar
35Wall, GM, Stroman, DW, Roland, PS, Dohar, J. Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J 2009;28:141–4Google Scholar
36Ramos, A, Ayudarte, F, de Miguel, I, Cuyás, JM, Cenjor, C. Use of topical ciprofloxacin in chronic suppurating otitis media [article in Spanish]. Acta Otorrinolaringol Esp 2003;54:485–90CrossRefGoogle ScholarPubMed
37Goldenberg, D, Golz, A, Netzer, A, Joachims, HZ. The use of otic powder in the treatment of acute external otitis. Am J Otolaryngol 2002;23:142–7CrossRefGoogle ScholarPubMed
38Rosenfeld, RM, Singer, M, Wasserman, JM, Stinnett, SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg 2006;134(suppl):2448Google Scholar
39Rosenfeld, RM, Brown, L, Cannon, CR, Dolor, RJ, Ganiats, TG, Hannley, M et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2006;134(suppl):423Google Scholar
40Roland, PS, Pien, FD, Schultz, CC, Henry, DC, Conroy, PJ, Wall, GM et al. Efficacy and safety of topical ciprofloxacin/dexamethasone versus neomycin/polymyxin B/hydrocortisone for otitis externa pain. Curr Med Res Opin 2004;20:1175–83Google Scholar
41Mösges, R, Nemantian-Samani, M, Eichel, A. Treatment of acute otitis externa with ciprofloxacin otic 0.2% antibiotic ear solution. Ther Clin Risk Manag 2011;7:325–36CrossRefGoogle ScholarPubMed