gramicidin-a and Chronic-Disease

Chronic suppurative otitis media (CSOM) affects many children in disadvantaged populations. The most appropriate topical antibiotic treatment in children with persistent disease is unclear.. Children with CSOM despite standard topical treatment were randomized to 6-8 weeks of topical ciprofloxacin (CIP) versus topical framycetin-gramicidin-dexamethasone (FGD). Otoscopic, audiologic, and microbiologic outcomes were measured using standardized assessments and blinding.. Ninety-seven children were randomized. Ear discharge failed to resolve at the end of therapy in 70% children regardless of allocation [risk difference = -2%; (95% CI: -20 to 16)]. Healing of the tympanic membrane occurred in one of 50 children in the CIP group and none of 47 children in the FGD group. Severity of discharge failed to improve in more than 50% children in each group, and mean hearing threshold (38 dB and 35 dB) and proportion of children with greater than 25 dB hearing loss (98% and 88%) were not significantly different between the CIP and FGD groups. Side effects were rare.. This study showed a similarly low rate of improvement or cure in children with persistent CSOM for both CIP and FGD topical therapies. Complications and side effects were insufficient to cease therapy or inform prescribing of either therapy.

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Australia; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Dexamethasone; Drug Therapy, Combination; Female; Framycetin; Gramicidin; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Otitis Media, Suppurative; Treatment Outcome

To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children.. Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM.. Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10-21 days after starting treatment.. 111 children aged 1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%).. Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Topics: Administration, Topical; Adolescent; Anti-Infective Agents; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Community Health Services; Dexamethasone; Drug Administration Schedule; Female; Framycetin; Gramicidin; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Otitis Media, Suppurative; Povidone-Iodine; Queensland; Treatment Outcome; Western Australia

Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming. This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks. Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.

Topics: Administration, Topical; Chronic Disease; Drug Administration Schedule; Drug Combinations; Gramicidin; Humans; Neomycin; Nystatin; Ointments; Otitis; Otitis Externa; Otitis Media, Suppurative; Triamcinolone Acetonide

Patients receiving Gentisone HC, Sofradex and Otomize for chronic suppurative otitis media and otitis externa were investigated for compliance of medication. Drops were accurately weighed before and after use so that both the amount used and the expected amount patients should have used could be calculated. The amount used differed statistically from the amount expected for Sofradex (P = 0.0008) but not for Gentisone HC (P = 0.1049) or Otomize (P = 0.7553) when analysed by a Mann-Whitney U-test. There was a trend to overdose with both Sofradex & Gentisone HC. The reason for the differences, we believe, is due to a combination of both differing delivery systems and drop viscosities. Manufacturers need to improve delivery systems so that patients can deliver a reproducible volume of medication each time with ease.

Topics: Administration, Topical; Chronic Disease; Dexamethasone; Drug Combinations; Framycetin; Gentamicins; Gramicidin; Humans; Hydrocortisone; Neomycin; Otitis Externa; Otitis Media, Suppurative; Patient Compliance; Statistics, Nonparametric

Topics: Acute Disease; Adolescent; Adult; Aged; Chronic Disease; Drug Combinations; Female; Gramicidin; Humans; Hypersensitivity; Male; Middle Aged; Neomycin; Nystatin; Ointments; Skin Diseases; Triamcinolone Acetonide