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SENSORY ORGANS › OPHTHALMOLOGICAL AND OTOLOGICAL PREPARATIONS › CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION › Corticosteroids and antiinfectives in combination
hydrocortisone and antiinfectives
S03CA04
Forms & Strengths
- Otic suspension: hydrocortisone 1% with polymyxin B sulfate and neomycin sulfate
- Otic solution: hydrocortisone 1% with polymyxin B sulfate and neomycin sulfate
- Otic drops: various combinations of hydrocortisone with ciprofloxacin, colistin, or other anti-infectives
Adult Dosing
- Otic suspension/solution: Instill 3 to 4 drops into the affected ear canal 3 to 4 times daily
- Duration of therapy typically ranges from 7 to 10 days based on clinical response
- Wick or gauze saturated with drops may be inserted if the ear canal is severely swollen
Pediatric Dosing
- Children (> 2 years): Instill 3 drops into the affected ear canal 3 to 4 times daily
- Children (< 2 years): Safety and efficacy are less well established; use with caution and limit duration
- Avoid prolonged use in pediatric patients to minimize systemic absorption and adrenal suppression
Indications
- Treatment of superficial bacterial infections of the external auditory canal caused by organisms susceptible to the antimicrobials
- Treatment of acute otitis externa complicated by inflammation, edema, and pruritus
Mechanism of Action
- Hydrocortisone provides anti-inflammatory, antipruritic, and vasoconstrictive activity via glucocorticoid receptor activation
- Polymyxin B is bactericidal against Gram-negative bacilli by binding to cell membrane phospholipids
- Neomycin is an aminoglycoside bactericidal against Gram-negative and some Gram-positive organisms via inhibition of bacterial protein synthesis
Contraindications
- Hypersensitivity to hydrocortisone, polymyxin B, neomycin, or any component of the formulation
- Viral infections of the external canal, including varicella and herpes simplex infections
- Fungal otic infections
- Perforated tympanic membrane (if containing ototoxic components like neomycin, though specific formulations may vary)
Adverse Reactions
- Local burning, stinging, irritation, or dryness at the application site
- Allergic contact dermatitis secondary to neomycin
- Superinfection with non-susceptible organisms or fungi upon prolonged use
- Ototoxicity (if the tympanic membrane is perforated)
Drug Interactions
- Significant systemic pharmacokinetic interactions are minimal due to low otic absorption
- Additive ototoxicity and nephrotoxicity possible if administered concurrently with other systemic aminoglycosides, especially if the tympanic membrane is perforated
Curated Content: Needs Vetting Before Put to Clinical Use