Patient compliance with short-term topical aural antibiotic therapy

Agius, Andee; Reid, A. P.; Cd, Hamilton

doi:10.1111/j.1365-2273.1994.tb01198.x

Cited by 20 publications

(15 citation statements)

References 7 publications

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“…Topical antibiotic drops are preferred to their oral counterparts as the therapeutic is delivered directly to the infected tissue. However, they require multiple daily applications over 7–10 days, and studies show that only 40% of patients who self-medicate do so appropriately, with the effectiveness of the therapy increasing when someone else other than the patient applies the drops [16,17].…”

Section: Introductionmentioning

confidence: 99%

A Controlled Antibiotic Release System for the Development of Single-Application Otitis Externa Therapeutics

Șerban

Stipe

Alverson

et al. 2017

Gels

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Ear infections are a commonly-occurring problem that can affect people of all ages. Treatment of these pathologies usually includes the administration of topical or systemic antibiotics, depending on the location of the infection. In this context, we sought to address the feasibility of a single-application slow-releasing therapeutic formulation of an antibiotic for the treatment of otitis externa. Thixotropic hydrogels, which are gels under static conditions but liquefy when shaken, were tested for their ability to act as drug controlled release systems and inhibit Pseudomonas aeruginosa and Staphylococcus aureus, the predominant bacterial strains associated with outer ear infections. Our overall proof of concept, including in vitro evaluations reflective of therapeutic ease of administration, formulation stability, cytocompatibility assessment, antibacterial efficacy, and formulation lifespan, indicate that these thixotropic materials have strong potential for development as otic treatment products.

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Section: Introductionmentioning

confidence: 99%

A Controlled Antibiotic Release System for the Development of Single-Application Otitis Externa Therapeutics

Șerban

Stipe

Alverson

et al. 2017

Gels

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“…Only 40% of patients who self-medicate do so appropriately during the first 3 days, 143 often tending to undermedicate. Adherence to therapy increases significantly when someone other than the patient applies the drops, 144 making this the preferred method of administration when feasible.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

128

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Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

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“…In addition to the high incidence of physician visits, recurrent AOM can develop into chronic AOM which may require expensive and invasive surgical intervention and/or result in detrimental long-term effects on hearing, speech, and learning [7][8][9][10][11][12][13]. Current standards of treatment remain oral antibiotics, which come with risk of systemic side effects and rise of antibiotic resistance [3,[16][17][18], and topical antibiotic drops, which come with issues of patient noncompliance due to frequency of dosing regimen and difficulty of administration and risk of local and systemic side effects due to high drug concentration required to overcome permeability barriers in the TM [21,[25][26][27][28]. For these reasons, drug delivery systems involving thermoresponsive hydrogels with or without degradable microspheres have been investigated in previous research studies [21,29,[31][32][33]65].…”

Section: Discussionmentioning

confidence: 99%

“…Thus with proper instillation, the standard topical antibiotic drop treatment [ 22 ] can deliver up to 1000 times excess antibiotic to the middle ear and surrounding tissues, which can contribute to local and systemic side effects much like their oral counterparts while not always effectively clearing infection due to limitations including low permeability and antibiotic resistant infections [ 25 ]. Further limitations of standard topical ear drops include low patient compliance, particularly when self-medicating and for treatment durations greater than 1 week, associated with high dosing frequency and difficulty of administration [ 26 – 28 ]. An ideal controlled release system should be simple to use and deliver to the middle ear an antibiotic dose closer to the target MIC at a frequency that is manageable by patients and/or their caregivers.…”

Section: Introductionmentioning

confidence: 99%

Controlled release of ciprofloxacin and ceftriaxone from a single ototopical administration of antibiotic-loaded polymer microspheres and thermoresponsive gel

et al. 2020

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Acute otitis media (AOM) is the main indication for pediatric antibiotic prescriptions, accounting for 25% of prescriptions. While the use of topical drops can minimize the administered dose of antibiotic and adverse systemic effects compared to oral antibiotics, their use has limitations, partially due to low patient compliance, high dosing frequency, and difficulty of administration. Lack of proper treatment can lead to development of chronic OM, which may require invasive interventions. Previous studies have shown that gel-based drug delivery to the ear is possible with intratympanic injection or chemical permeation enhancers (CPEs). However, many patients are reluctant to accept invasive treatments and CPEs have demonstrated toxicity to the tympanic membrane (TM). We developed a novel method of delivering therapeutics to the TM and middle ear using a topical, thermoresponsive gel depot containing antibiotic-loaded poly(lactic-co-glycolic acid) microspheres. Our in vitro and ex vivo results suggest that the sustained presentation can safely allow therapeutically relevant drug concentrations to penetrate the TM to the middle ear for up to 14 days. Animal results indicate sufficient antibiotic released for treatment from topical administration 24h after bacterial inoculation. However, animals treated 72h after inoculation, a more clinically relevant treatment practice, displayed spontaneous clearance of infection as is also often observed in the clinic. Despite this variability in the disease model, data suggest the system can safely treat bacterial infection, with future studies necessary to optimize microsphere formulations for scaled up dosage of antibiotic as well as further investigation of the influence of spontaneous bacterial clearance and of biofilm formation on effectiveness of treatment. To our knowledge, this study represents the first truly topical drug delivery system to the middle ear without the use of CPEs.

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Patient compliance with short-term topical aural antibiotic therapy

Cited by 20 publications

References 7 publications

A Controlled Antibiotic Release System for the Development of Single-Application Otitis Externa Therapeutics

A Controlled Antibiotic Release System for the Development of Single-Application Otitis Externa Therapeutics

Clinical Practice Guideline: Acute Otitis Externa

Controlled release of ciprofloxacin and ceftriaxone from a single ototopical administration of antibiotic-loaded polymer microspheres and thermoresponsive gel

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