When to use Kenacomb (triamcinolone, neomycin, nystatin) ear drops in the management of otitis externa?

From the Guidelines

Kenacomb ear drops should be used in the management of otitis externa when there is suspected or confirmed mixed infection involving bacteria and fungi, particularly when inflammation is significant, as they provide a broad spectrum of coverage with triamcinolone, neomycin, and nystatin 1.

Key Considerations for Use

• The decision to use Kenacomb or any other eardrop should be based on the clinical presentation, including the severity of symptoms and the presence of any complicating factors such as a perforated tympanic membrane or prior ear surgery 1.
• It is essential to clean the ear canal gently before applying the drops to ensure effective penetration of the medication.
• Patients should be advised to use the drops for the recommended duration, typically 7-10 days, even if symptoms improve sooner, to prevent relapse of infection 1.

Administration and Precautions

• To administer Kenacomb ear drops, tilt the head with the affected ear upward, pull the outer ear gently upward and backward (in adults) or downward and backward (in children) to straighten the ear canal, and instill 2-3 drops three to four times daily.
• Maintain the head position for 1-2 minutes after instillation to allow proper distribution of the medication.
• Patients should avoid inserting objects into the ear canal, including cotton-tipped swabs, and should cover the ear canal with an earplug or cotton with petroleum jelly before showering or hair washing to minimize water entry 1.

Monitoring and Side Effects

• Patients should be monitored for improvement in symptoms within 48 to 72 hours and should notify their doctor if symptoms fail to respond or worsen 1.
• Common side effects of eardrops are local and may include rash, itching, irritation, or discomfort, but these are rarely severe enough to require discontinuation of the medication 1.
• If the patient experiences a taste of the eardrops, this may indicate a perforated tympanic membrane, and they should inform their doctor promptly 1.

From the FDA Drug Label

For adults, 4 drops of the suspension should be instilled into the affected ear 3 or 4 times daily. Therapy with this product should be limited to 10 consecutive days. Neomycin and Polymyxin B Sulfates and Hydrocortisone Otic Suspension should not be used in any patient with a perforated tympanic membrane.

Management of Otitis Externa with Kenacomb Ear Drops:

• Kenacomb ear drops can be used in the management of otitis externa.
• The recommended dosage is 4 drops into the affected ear 3 or 4 times daily for adults.
• Therapy should be limited to 10 consecutive days 2.
• Contraindication: Kenacomb ear drops should not be used in patients with a perforated tympanic membrane 2.
• It is essential to shake the suspension well before using and to cleanse and dry the external auditory canal before instillation 2.

From the Research

Management of Otitis Externa with Kenacomb Ear Drops

• Kenacomb ear drops, containing triamcinolone, neomycin, and nystatin, are used in the management of otitis externa.
• The decision to use Kenacomb ear drops should be based on the severity of the infection and the presence of bacterial or fungal components 3, 4.
• A study published in 2002 found that the use of an aminoglycoside antibiotic, such as neomycin, may not convey significant benefits in the treatment of otitis externa 3.
• However, another study published in 2004 found that a combination of ciprofloxacin and dexamethasone was more effective than a combination of neomycin, polymyxin B, and hydrocortisone in the treatment of acute otitis externa 4.
• The choice of topical treatment for otitis externa should be based on factors such as the risk of ototoxicity, contact sensitivity, and resistance, as well as availability, cost, and dosing schedule 5.

Indications for Kenacomb Ear Drops

• Kenacomb ear drops may be indicated for the treatment of otitis externa with a significant inflammatory component, as triamcinolone has anti-inflammatory properties.
• The presence of a fungal infection, such as Candida or Aspergillus, may also indicate the use of Kenacomb ear drops, as nystatin has antifungal properties 6, 7.
• However, the use of Kenacomb ear drops should be guided by the results of microbiological testing, as the presence of resistant organisms may require alternative treatment 7.

Duration of Treatment with Kenacomb Ear Drops

• The duration of treatment with Kenacomb ear drops should be individualized based on the severity of the infection and the patient's response to treatment.
• Patients may be instructed to use the ear drops for at least a week, and to continue treatment until symptoms resolve, for a maximum of a further seven days 5.
• Patients with persisting symptoms beyond two weeks should be considered treatment failures and alternative management initiated 5.