Mösges R, Nematian-Samani M, Eichel A

Abstract

Background/objective
An 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.

Methods
After 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.

Results
The 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.

Conclusion
This systematic review confirms the hypothesis of ciprofloxacin’s noninferiority in the treatment of otitis externa, in terms of the cure rate and microbiological eradication.

Summary

One of the H&Ps I presented was a 19 year old patient that complained of bilateral ear pain, upon exam she had swelling in both canals and we were unable to visualize either TM. There are a number of topical options that can be used to treat acute otitis externa so I wanted to find an article that compared the efficacy of these treatment options. This article is a systematic review that used 14 RCTs to compare ciprofloxacin 0.2% or 0.3% drops alone or in combination with the other treatments including polymyxin B/neomycin/hydrocortisone (PNH), auricularum powder, ciprofloxacin foam. They assessed clinical response, time to end of pain, microbial cure, adverse events, and risk of bias. The authors concluded by acknowledging the efficacy of Ciprofloxacin 0.2% drops as they had consistently higher success rates than other treatments, eradication P. aeruginosa, and also did not show ototoxicity. There was also a low rate of adverse effects, and these did not cause any patients to discontinue use of the medication.