What is the recommended treatment for otitis externa using Neomycin (neomycin sulfate)?

From the Guidelines

For otitis externa, the recommended treatment using Neomycin involves applying neomycin-containing ear drops to the affected ear canal, typically 3-4 drops, 3-4 times daily for 7-10 days. Before application, the ear canal should be gently cleaned of debris and discharge. The patient should lie with the affected ear upward for 2-3 minutes after instillation to ensure proper distribution of the medication. Neomycin is often combined with polymyxin B and a corticosteroid (like hydrocortisone) in commercial preparations to provide both antimicrobial and anti-inflammatory effects. This combination addresses both the infection and inflammation characteristic of otitis externa. It's essential to complete the full course of treatment even if symptoms improve earlier. Patients should avoid getting water in the ear during treatment and should not use cotton swabs which can push debris deeper into the canal. If symptoms worsen or don't improve after 3-5 days, medical reevaluation is necessary as neomycin occasionally causes contact dermatitis or may be ineffective against certain pathogens 1.

Key Considerations

• The ear canal should be cleared of inflammatory debris, obstructing cerumen, or any foreign object before applying neomycin drops 1.
• Patients with diabetes, an immunocompromised state, or both require special consideration because they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1.
• Neomycin-containing eardrops are most commonly noted to cause contact sensitivity, which has a 13% to 30% prevalence on patch testing of patients with chronic otitis externa 1.

Treatment Duration and Follow-Up

• Eardrops should be used for at least 7 days, even if the patient feels better sooner, to prevent relapse of infection 1.
• If symptoms persist beyond 7 days, the patient should notify their doctor and continue the drops until the symptoms resolve for a maximum of 7 additional days 1.

From the FDA Drug Label

The safety and effectiveness of neomycin and polymyxin B sulfates and hydrocortisone otic solution in otitis externa have been established in the pediatric age group 2 years to 16 years of age.

The recommended treatment for otitis externa using Neomycin is neomycin and polymyxin B sulfates and hydrocortisone otic solution.

• Treatment should not be continued for longer than 10 days.
• If the infection is not improved after 1 week, cultures and susceptibility tests should be repeated to verify the identity of the organism and to determine whether therapy should be changed 2.

From the Research

Treatment of Otitis Externa with Neomycin

• Neomycin sulfate is a commonly used antibiotic for the treatment of otitis externa, often in combination with polymyxin B sulfate and hydrocortisone 3, 4, 5.
• The typical dosage of neomycin sulfate for otitis externa is not explicitly stated in the provided studies, but it is often administered 3-4 times daily for 7-10 days 4, 5.
• Studies have shown that neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension is effective in treating otitis externa, with cure rates ranging from 88% to 94.7% 3, 4.
• However, neomycin sulfate has been associated with ototoxicity, which can be a concern for some patients 4.
• Alternative treatments, such as ofloxacin otic solution, have been shown to be as effective as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension, with the added benefit of less frequent dosing and no risk of ototoxicity 3, 4.

Comparison with Other Treatments

• A study comparing neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension with ofloxacin otic solution found that both treatments were effective in treating otitis externa, but ofloxacin otic solution had a higher cure rate (96.4% vs 97.1%) and was better tolerated 4.
• Another study found that ciprofloxacin and hydrocortisone was clinically equivalent to neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension plus amoxicillin for the treatment of acute otitis externa 5.
• In vitro studies have shown that the combination of neomycin and polymyxin B has synergistic effects against pathogens responsible for otitis externa, including Pseudomonas aeruginosa 6.

Safety and Efficacy

• Neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension has been shown to be safe and effective in treating otitis externa, with minimal adverse events reported 3, 4, 5.
• However, the use of neomycin sulfate has been associated with ototoxicity, which can be a concern for some patients 4.
• Alternative treatments, such as ofloxacin otic solution, have been shown to be safe and effective, with minimal adverse events reported 3, 4.