Differences in bacteriologic treatment failures in acute otitis externa between ciprofloxacin/dexamethasone and neomycin/polymyxin B/hydrocortisone: Results of a combined analysis

Joseph E. Dohar, Peter Roland, G. Michael Wall, Celeste McLean, David W. Stroman

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To compare treatment failure rates for the two major acute otitis externa (AOE) pathogens, Pseudomonas aeruginosa and Staphylococcus aureus, by topical therapy with ciprofloxacin 0.3%/dexamethasone 0.1% (CDex) or neomycin 0.35%/polymyxin B 10 000 IU/mL/hydrocortisone 1% (Cort) based on clinical and microbiological failure in patients positive for these pathogens at baseline. Research design and methods: A combined analysis was conducted from two similar, but non-identical clinical trials involving CDex vs. Cort. Outcomes of the combined efficacy analysis were treatment failure rates and antibiotic susceptibility values for P. aeruginosa and S. aureus. The raw data for the treatment failure rates from the two studies were combined to calculate the overall treatment failure rates of each treatment group. Chi-square tests of independence were conducted to assess differences in treatment failure rates between treatment groups. Results: Of the 789 patients with culture-positive ears prior to the initiation of therapy, 61.0% (n=481) were positive for P. aeruginosa and 8.9% (n=70) were positive for S. aureus. While treatment failure rates for S. aureus were similar for the two therapies, CDex had a significantly lower treatment failure rate than Cort (5.1 vs. 13.0%; p=0.0044) for P. aeruginosa. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B. Limitations: The analysis strength is dependent on pooled data from similar studies. Conclusions: Ototopical ciprofloxacin 0.3%/dexamethasone 0.1% more effectively eradicates P. aeruginosa compared to Cort. Eradication of S. aureus by either drug was similar. These results favor CDex as a better first-line choice in the treatment of AOE compared to Cort.

Original languageEnglish (US)
Pages (from-to)287-291
Number of pages5
JournalCurrent Medical Research and Opinion
Volume25
Issue number2
DOIs
StatePublished - Feb 2009

Fingerprint

Otitis Externa
Ciprofloxacin
Treatment Failure
Hydrocortisone
Pseudomonas aeruginosa
Staphylococcus aureus
Dexamethasone
Polymyxin B
Therapeutics
Framycetin
Neomycin
Fluoroquinolones
Chi-Square Distribution
dexamethasone, neomycin, polymyxin B drug combination
Ear
Research Design
Clinical Trials
Anti-Bacterial Agents

Keywords

  • Acute otitis externa
  • Antibacterial therapy
  • Ciprofloxacin
  • Combined analysis
  • Neomycin
  • Polymyxin B
  • Pseudomonas aeruginosa
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Differences in bacteriologic treatment failures in acute otitis externa between ciprofloxacin/dexamethasone and neomycin/polymyxin B/hydrocortisone : Results of a combined analysis. / Dohar, Joseph E.; Roland, Peter; Wall, G. Michael; McLean, Celeste; Stroman, David W.

In: Current Medical Research and Opinion, Vol. 25, No. 2, 02.2009, p. 287-291.

Research output: Contribution to journalArticle

@article{e8978af4558e4ca1ba47ec7ef790a0f7,
title = "Differences in bacteriologic treatment failures in acute otitis externa between ciprofloxacin/dexamethasone and neomycin/polymyxin B/hydrocortisone: Results of a combined analysis",
abstract = "Objective: To compare treatment failure rates for the two major acute otitis externa (AOE) pathogens, Pseudomonas aeruginosa and Staphylococcus aureus, by topical therapy with ciprofloxacin 0.3{\%}/dexamethasone 0.1{\%} (CDex) or neomycin 0.35{\%}/polymyxin B 10 000 IU/mL/hydrocortisone 1{\%} (Cort) based on clinical and microbiological failure in patients positive for these pathogens at baseline. Research design and methods: A combined analysis was conducted from two similar, but non-identical clinical trials involving CDex vs. Cort. Outcomes of the combined efficacy analysis were treatment failure rates and antibiotic susceptibility values for P. aeruginosa and S. aureus. The raw data for the treatment failure rates from the two studies were combined to calculate the overall treatment failure rates of each treatment group. Chi-square tests of independence were conducted to assess differences in treatment failure rates between treatment groups. Results: Of the 789 patients with culture-positive ears prior to the initiation of therapy, 61.0{\%} (n=481) were positive for P. aeruginosa and 8.9{\%} (n=70) were positive for S. aureus. While treatment failure rates for S. aureus were similar for the two therapies, CDex had a significantly lower treatment failure rate than Cort (5.1 vs. 13.0{\%}; p=0.0044) for P. aeruginosa. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B. Limitations: The analysis strength is dependent on pooled data from similar studies. Conclusions: Ototopical ciprofloxacin 0.3{\%}/dexamethasone 0.1{\%} more effectively eradicates P. aeruginosa compared to Cort. Eradication of S. aureus by either drug was similar. These results favor CDex as a better first-line choice in the treatment of AOE compared to Cort.",
keywords = "Acute otitis externa, Antibacterial therapy, Ciprofloxacin, Combined analysis, Neomycin, Polymyxin B, Pseudomonas aeruginosa, Staphylococcus aureus",
author = "Dohar, {Joseph E.} and Peter Roland and Wall, {G. Michael} and Celeste McLean and Stroman, {David W.}",
year = "2009",
month = "2",
doi = "10.1185/03007990802603072",
language = "English (US)",
volume = "25",
pages = "287--291",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Taylor and Francis Ltd.",
number = "2",

}

TY - JOUR

T1 - Differences in bacteriologic treatment failures in acute otitis externa between ciprofloxacin/dexamethasone and neomycin/polymyxin B/hydrocortisone

T2 - Results of a combined analysis

AU - Dohar, Joseph E.

AU - Roland, Peter

AU - Wall, G. Michael

AU - McLean, Celeste

AU - Stroman, David W.

PY - 2009/2

Y1 - 2009/2

N2 - Objective: To compare treatment failure rates for the two major acute otitis externa (AOE) pathogens, Pseudomonas aeruginosa and Staphylococcus aureus, by topical therapy with ciprofloxacin 0.3%/dexamethasone 0.1% (CDex) or neomycin 0.35%/polymyxin B 10 000 IU/mL/hydrocortisone 1% (Cort) based on clinical and microbiological failure in patients positive for these pathogens at baseline. Research design and methods: A combined analysis was conducted from two similar, but non-identical clinical trials involving CDex vs. Cort. Outcomes of the combined efficacy analysis were treatment failure rates and antibiotic susceptibility values for P. aeruginosa and S. aureus. The raw data for the treatment failure rates from the two studies were combined to calculate the overall treatment failure rates of each treatment group. Chi-square tests of independence were conducted to assess differences in treatment failure rates between treatment groups. Results: Of the 789 patients with culture-positive ears prior to the initiation of therapy, 61.0% (n=481) were positive for P. aeruginosa and 8.9% (n=70) were positive for S. aureus. While treatment failure rates for S. aureus were similar for the two therapies, CDex had a significantly lower treatment failure rate than Cort (5.1 vs. 13.0%; p=0.0044) for P. aeruginosa. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B. Limitations: The analysis strength is dependent on pooled data from similar studies. Conclusions: Ototopical ciprofloxacin 0.3%/dexamethasone 0.1% more effectively eradicates P. aeruginosa compared to Cort. Eradication of S. aureus by either drug was similar. These results favor CDex as a better first-line choice in the treatment of AOE compared to Cort.

AB - Objective: To compare treatment failure rates for the two major acute otitis externa (AOE) pathogens, Pseudomonas aeruginosa and Staphylococcus aureus, by topical therapy with ciprofloxacin 0.3%/dexamethasone 0.1% (CDex) or neomycin 0.35%/polymyxin B 10 000 IU/mL/hydrocortisone 1% (Cort) based on clinical and microbiological failure in patients positive for these pathogens at baseline. Research design and methods: A combined analysis was conducted from two similar, but non-identical clinical trials involving CDex vs. Cort. Outcomes of the combined efficacy analysis were treatment failure rates and antibiotic susceptibility values for P. aeruginosa and S. aureus. The raw data for the treatment failure rates from the two studies were combined to calculate the overall treatment failure rates of each treatment group. Chi-square tests of independence were conducted to assess differences in treatment failure rates between treatment groups. Results: Of the 789 patients with culture-positive ears prior to the initiation of therapy, 61.0% (n=481) were positive for P. aeruginosa and 8.9% (n=70) were positive for S. aureus. While treatment failure rates for S. aureus were similar for the two therapies, CDex had a significantly lower treatment failure rate than Cort (5.1 vs. 13.0%; p=0.0044) for P. aeruginosa. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B. Limitations: The analysis strength is dependent on pooled data from similar studies. Conclusions: Ototopical ciprofloxacin 0.3%/dexamethasone 0.1% more effectively eradicates P. aeruginosa compared to Cort. Eradication of S. aureus by either drug was similar. These results favor CDex as a better first-line choice in the treatment of AOE compared to Cort.

KW - Acute otitis externa

KW - Antibacterial therapy

KW - Ciprofloxacin

KW - Combined analysis

KW - Neomycin

KW - Polymyxin B

KW - Pseudomonas aeruginosa

KW - Staphylococcus aureus

UR - http://www.scopus.com/inward/record.url?scp=64249110196&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64249110196&partnerID=8YFLogxK

U2 - 10.1185/03007990802603072

DO - 10.1185/03007990802603072

M3 - Article

C2 - 19192973

AN - SCOPUS:64249110196

VL - 25

SP - 287

EP - 291

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 2

ER -