nystatin-a1 and Otitis-Externa

Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Drug Combinations; Female; Glycerol; Gramicidin; Humans; Male; Middle Aged; Neomycin; Nystatin; Otitis Externa; Pain Measurement; Quaternary Ammonium Compounds; Solvents; Treatment Outcome; Triamcinolone Acetonide

Otitis externa (OE) is a common disorder which can cause severe pain and discomfort with discharge and hearing loss. The majority of topical preparations for OE treatment contain a combination of steroids and antibiotics and are administered as ear drops. Otic powder preparations are less common. We found no studies which compared the efficacy of the two dosage forms.. The purpose of the study was to compare the healing process of the external ear canal when treated locally either with otic powder (Auricularum), a preparation containing antibiotic, steroidal and antimycotic components, or with otic drops (Dex-Otic), a commercial ear drop preparation containing antibiotic and steroidal components.. The study was designed as an open, randomised, comparative clinical trial. Ambulatory patients suffering from OE were examined by an ear specialist and randomly divided into an otic powder (Auricularum) treatment group and an ear drop (Dex-Otic) treatment group. Each treatment group was treated in accordance with the daily doses recommended by the manufacturers. Patients were treated for a period of 14 days and examined on days 0, 3, 7, 10 and 14. Clinical signs and symptoms recorded were pain, erythema, swelling and discharge.. A total of 67 patients entered the study. The probability of healing within 7 days was 74% in the otic powder group as opposed to 40% in the ear drops group (log rank test, p = 0.0013). The probability of total pain relief after 3 days of treatment was 60% in the otic powder group compared to 53% in the ear drops group (log rank test, p = 0.0001).. We conclude that treatment with an otic powder (Auricularum) may promote earlier healing and pain relief than does treatment with otic drops (Dex-Otic).

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Inflammatory Agents; Chemistry, Pharmaceutical; Dexamethasone; Drug Combinations; Female; Humans; Israel; Male; Middle Aged; Nystatin; Otitis Externa; Oxytetracycline; Polymyxin B; Treatment Outcome

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

A double-blind, randomised clinical trial was conducted in Queensland general practices to evaluate the efficacy of oral doses of trimethoprim-sulfamethoxazole (cotrimoxazole) as an adjunct to Kenacomb ointment in the treatment of acute diffuse otitis externa.. One hundred and five patients with otitis externa agreed to enter the trial; 13 of these had bilateral otitis externa. Six symptoms and signs of otitis externa were rated on a scale of 1 (none) to 5 (severe) and then the scores were averaged to give an index of severity. Swabs from all infected ears were cultured and then the patients were treated with Kenacomb ointment. Patients were randomly assigned to take a five-day course of either oral cotrimoxazole or an oral placebo and were reassessed on Days 2-4 and Days 5-6 after presentation.. The mean duration (+/- standard deviation) of ear pain from the first visit for the cotrimoxazole and placebo groups was 3.1 (+/- 1.5) days and 3.1 (+/- 1.7) days respectively. The mean severity indices (+/- standard deviation) for these groups on presentation were 2.33 (+/- 0.59) and 2.37 (+/- 0.57). The respective reductions in these scores by the second visit were 0.72 and 0.69 and by the third visit 1.10 and 1.05. The principle pathogen isolated was Pseudomonas aeruginosa.. This suggests that oral cotrimoxazole is unlikely to be useful as an adjunct to Kenacomb ointment in the treatment of mild to moderate otitis externa.

Topics: Administration, Oral; Adult; Child; Double-Blind Method; Drug Combinations; Earache; Female; Gramicidin; Humans; Male; Neomycin; Nystatin; Otitis Externa; Placebos; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Tablets; Triamcinolone Acetonide; Trimethoprim, Sulfamethoxazole Drug Combination

Ten patients with bilateral moderate or severe otitis externa were studied. Following aural toilet each patient was subjected to two different treatments: one ear had alternate day dressings containing a topical antibiotic/steroid mixture, while the external canal of the other was filled with the same topical preparation (sump filling). Improvement in the severity of the otitis externa was assessed after 1 week. 9 out of 10 ear canals improved in each group. An estimate of the relative cost of each treatment was made and sump filling was found to be less expensive. The results suggest that sump filling is a low cost alternative to standard treatment in moderate and severe otitis externa.

Topics: Administration, Topical; Bandages; Fluocinolone Acetonide; Gentamicins; Humans; Injections; Nystatin; Otitis Externa; Oxytetracycline; Prospective Studies; Syringes

A topical preparation containing miconazole, polymyxin and prednisolone was shown to be more effective in the treatment of otitis externa in 167 dogs than 2 other ear preparations containing antibiotics, an antimycotic and a corticosteroid. With miconazole, polymyxin and prednisolone, the recurrence rate was 26.7% compared with 72.6% and 54.3% when the other products were used. The mean duration of treatment required to achieve resolution of clinical signs was 9.6 days, compared with 12.2 days and 13.0 days and no cases failed to respond to treatment, compared with 17.7% and 14.3%. Malassezia canis alone (71%) or in association with bacteria (18%) was recovered from 44 of 49 ears cultured.

Topics: Administration, Topical; Animals; Betamethasone; Disulfiram; Dog Diseases; Dogs; Drug Combinations; Miconazole; Neomycin; Nystatin; Otitis Externa; Polymyxin B; Prednisolone; Recurrence; Thiostrepton; Triamcinolone

A new preparation containing clobetasol propionate, tetracycline and nystatin was compared with Otosporin in the the treatment of otitis externa. Thirty-two patients with bilateral disease and seventeen with unilateral disease completed the trial. Signs and symptoms were assessed by the clinician initially and at varying times after treatment. Both preparations were effective in relieving the symptoms with the majority of patients noticing improvement within seven days. Clobetasol propionate ear drops were significantly better than Otosporin when assessed on the patient's last visit to the hospital (p less than 0.05). There were less relapses in the clobetasol propionate group than in the Otosporin group.

Topics: Adolescent; Adult; Aged; Betamethasone; Child; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Drug Combinations; Female; Humans; Hydrocortisone; Male; Middle Aged; Neomycin; Nystatin; Otitis Externa; Polymyxins; Random Allocation; Tetracycline

The effect on canine otitis externa of a topical preparation composed of Fucidin, Framycetin, Nystatin, and Prednisolone was evaluated in a clinical trial comprising 235 dog ears. Cases caused by parasites or foreign bodies and cases requiring systemic therapy were excluded. Swabs from these and an additional 434 affected ears were examined bacteriologically and the sensitivity to antibiotics of the bacteria isolated determined. The infection most frequently diagnosed was staphylococci plus yeasts (29 % of total material) followed by pure yeast-infections (19 %) and pure staphylococcus infections (16 %). Pseudomonas aeruginosa and/or Proteus mirabilis were found in 7 % of the ears, while no organisms could be isolated from 22 %. Sensitivity tests showed a satisfactory in vitro effect of Neomycin (Framycetin) on most of the bacteria commonly isolated, and a very good effect of Fucidin on the staphylococci. Approximately 91 % of the ears treated were clinically cured or improved very considerably; the relation between clinical response and type of infection is shown diagrammatically in Fig. 1. It was confirmed that infections with Ps. aeruginosa represent a special problem; the results of post-treatment sensitivity tests seem to suggest, however, that a longer or more intense course of treatment than the one used in the trial (two weeks) would provide the answer to this.

Topics: Animals; Clinical Trials as Topic; Dog Diseases; Dogs; Drug Combinations; Fusidic Acid; Microbial Sensitivity Tests; Neomycin; Nystatin; Otitis Externa; Prednisolone; Proteus; Pseudomonas aeruginosa; Staphylococcus; Yeasts

Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth.. The study aimed to identify the causative agents of otomycosis and determine corresponding antifungal drug susceptibility patterns in north-western Iran.. From October 2020 until November 2021, 200 patients attended an otolaryngology referral centre with otitis externa, and their ear discharge and debris were examined and cultured. The identification of the fungal agents was implemented by polymerase chain reaction-restriction fragment length polymorphism and sequencing. In vitro antifungal susceptibility testing of the isolates was conducted in accordance with the CLSI broth microdilution protocols.. The prevalence of otomycosis was measured 50.5% (n = 101/200). The majority of patients were in their forties (n = 35, 34.6%) and female (n = 57, 56.4%), and the most prevalent symptom was otalgia (56.4%). The most underlying factor was remarked manipulation employing a cotton swab (65.3%). Regarding fungus, Aspergillus section Nigri (58.57%) was the foremost isolate, followed by Aspergillus section Flavi (19.23%) and Candida parapsilosis (14.96%). The predominance of Aspergillus isolates had minimal in vitro sensitivity to tioconazole and nystatin. Candida species represented higher geometric mean minimum inhibitory concentrations (MIC) against nystatin. The MIC of three Aspergillus species isolates shown above the epidemiologic cut-off values (ECV) against itraconazole.. Otomycosis incidence surpassed in comparison with the previous study as the most common cause of otitis externa. The MIC distribution of Aspergillus species isolates against triazole antifungals is close to the defined ECVs and likely outrun it over time.

Topics: Antifungal Agents; Aspergillus; Female; Humans; Iran; Microbial Sensitivity Tests; Nystatin; Otitis Externa; Otomycosis

The emerging pathogen Candida auris is isolated mostly from hospitalized patients and often shows multidrug resistance. We report on the isolation of this yeast in Austria from an outpatient's auditory canal. The isolate showed good susceptibility against antifungals except for echinocandins; the patient was treated successfully with topical administration of nystatin.

Topics: Antifungal Agents; Austria; Candida; Candidiasis; DNA, Fungal; Drug Resistance, Fungal; Ear Canal; Humans; Male; Microbial Sensitivity Tests; Nystatin; Otitis Externa; Young Adult

The antifungal activity of beta-thujaplicin was evaluated against 51 Malassezia pachydermatis strains isolated from canine ear canals with or without otitis externa. For comparison, sensitivity tests were performed on M. pachydermatis isolates for nystatin, ketoconazole, and terbinafine HCl, all clinically available antifungal agents. The minimal inhibition concentrations over 50% of the tested isolates (MIC50) were 3.13 microg/ml for beta-thujaplicin and nystatin, 0.016 microg/ml for ketoconazole, and 1.56 microg/ml for terbinafine HCl. The antifungal effect for M. pachydermatis of beta-thujaplicin compared favorably with commercial antifungal agents. None of the 51 M. pachydermatis isolates showed resistance against any of the tested antibiotics investigated in this study. Ten representative isolates of M. pachydermatis were subcultured for 30 generations at concentrations close to the MIC levels of beta-thujaplicin, nystatin, ketoconazole, and terbinafine HCl, and examined to determine whether they had acquired resistance to each drug. As a result, M. pachydermatis was found to achieve resistance more easily for ketoconazole and terbinafine HCl than for beta-thujaplicin or nystatin. The MIC50 of beta-thujaplicin did not change during the course of subculture, and it is thought that the potential development of a resistant strain is low, even with continuous infusion for otitis externa therapy. beta-Thujaplicin is an inexpensive and safe treatment with anti-inflammatory and deodorant effects that can be recommended as an effective remedy for canine otitis externa.

Topics: Animals; Antifungal Agents; Dermatomycoses; Dog Diseases; Dogs; Drug Resistance, Fungal; Ketoconazole; Malassezia; Microbial Sensitivity Tests; Monoterpenes; Naphthalenes; Nystatin; Otitis Externa; Species Specificity; Terbinafine; Tropolone

It is important to test the antimicrobial sensitivity of the aetiological agents of otitis externa before starting treatment in order to prevent the development of antibiotic resistance in the microorganisms. In this study the sensitivity patterns in bacteria and yeasts isolated as aetiological agents from otitis externa were analysed. Antifungal and antibacterial activity tests were done using the automated system ATB Fungus and the classic diffusion test respectively. The azole compounds had the greatest antifungal properties, while beta-lactams had the strongest antibiotic activity. This study reflects the increasing importance of sensitivity tests in chronic otitis externa due to the increasing antimicrobial resistances in bacteria and yeasts. If it is necessary to initiate an empiric treatment before the results of the antimicrobial test, the application of miconazole or econazole for yeasts and oxacillin or amoxicillin-clavulanic acid against bacteria is recommended.

Topics: Amphotericin B; Animals; Antifungal Agents; Dog Diseases; Dogs; Econazole; Miconazole; Microbial Sensitivity Tests; Nystatin; Otitis Externa

Topics: Animals; Antifungal Agents; Clotrimazole; Dog Diseases; Dogs; Humans; Ketoconazole; Malassezia; Miconazole; Microbial Sensitivity Tests; Natamycin; Nystatin; Otitis Externa

Budding yeasts were present in the majority of cases of otitis externa examined. A reddish-brown, dry, waxy discharge was the typical exudate. A successful treatment of yeast-infected ears was multiple otic lavages using a combination of an aqueous solution of poloxamer-iodine and application of an antifungal-antibiotic-corticosteroids ointment.

Topics: Animals; Antifungal Agents; Candida; Candidiasis; Dog Diseases; Dogs; Drug Combinations; Iodine; Malassezia; Neomycin; Nystatin; Otitis Externa; Poloxalene; Thiostrepton; Tinea Versicolor; Triamcinolone