What is the dosage and treatment protocol for Locacorten-Vioform (neomycin and fluocinolone) ear drops for inflammatory ear conditions?

From the Guidelines

Locacorten-Vioform ear drops should be administered as 2-3 drops into the affected ear canal three times daily for 7-10 days for inflammatory ear conditions. The patient should lie with the affected ear upward for 3-5 minutes after instillation to ensure proper distribution of the medication, as recommended by 1 and 1. Before application, the ear should be gently cleaned of any discharge. For children, the dosage may be reduced to 1-2 drops three times daily. Treatment should not exceed 10 days without reassessment, as prolonged use can lead to bacterial resistance or fungal overgrowth, as noted in the guidelines 1.

Important Administration Instructions

• The ear canal should be cleared of inflammatory debris, obstructing cerumen, or any foreign object before administering the drops, as suggested by 1.
• A gentle to-and-fro movement of the pinna or tragal pumping may be necessary to eliminate trapped air and ensure filling of the ear canal with the medication.
• Patients should avoid getting water in the ear during treatment and complete the full course of treatment even if symptoms improve earlier.
• If symptoms worsen or do not improve after 3-5 days, medical reassessment is necessary.

Special Considerations

• For patients with risk factors such as diabetes or immunocompromised state, atraumatic cleaning with aural suctioning under microscopic guidance may be required, as indicated by 1.
• The medication works through a dual mechanism: fluocinolone provides anti-inflammatory effects, while neomycin targets bacterial infections commonly associated with ear inflammation.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Therapy with this product should be limited to 10 consecutive days. The external auditory canal should be thoroughly cleansed and dried with a sterile cotton applicator. For adults, 4 drops of the suspension should be instilled into the affected ear 3 or 4 times daily. For children, 3 drops are suggested because of the smaller capacity of the ear canal The patient should lie with the affected ear upward and then the drops should be instilled. This position should be maintained for 5 minutes to facilitate penetration of the drops into the ear canal. If preferred, a cotton wick may be inserted into the canal and then the cotton may be saturated with the suspension This wick should be kept moist by adding further suspension every 4 hours. The wick should be replaced at least once every 24 hours. SHAKE WELL BEFORE USING.

The dosage for Locacorten-Vioform ear drops is:

• 4 drops for adults, 3 or 4 times daily
• 3 drops for children, 3 or 4 times daily The treatment protocol is to use the ear drops for a maximum of 10 consecutive days. It is also recommended to:
• Clean and dry the ear canal before use
• Use a cotton wick if preferred, replacing it at least every 24 hours
• Keep the wick moist by adding suspension every 4 hours 2

From the Research

Dosage and Treatment Protocol for Locacorten-Vioform Ear Drops

• The dosage and treatment protocol for Locacorten-Vioform (neomycin and fluocinolone) ear drops are not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that topical antimicrobials containing steroids, such as Locacorten-Vioform, are effective in treating inflammatory ear conditions like acute otitis externa 4, 5.
• The treatment protocol for acute otitis externa typically involves the use of topical ear drops for 7-10 days, with the option to extend treatment for a further 7 days if symptoms persist 4.
• It is essential to note that the choice of topical treatment may be determined by factors such as risk of ototoxicity, risk of contact sensitivity, risk of developing resistance, availability, cost, and dosing schedule 4.
• Patients prescribed antibiotic/steroid drops, like Locacorten-Vioform, can expect their symptoms to last for approximately six days after treatment has begun 4.

Considerations for Locacorten-Vioform Use

• The use of Locacorten-Vioform ear drops may be associated with ototoxicity, as suggested by a study that found significant hearing loss in guinea pigs treated with the medication 3.
• The development of resistance to neomycin and polymyxin B, components of Locacorten-Vioform, has been reported in clinical trials 7.
• Alternative treatments, such as group III steroid solutions without antibiotic components, may be effective in treating external otitis and have a lower risk of adverse effects 6.