From the Guidelines
Kencomb (neomycin) drops are not recommended as first-line treatment for a right ear infection with heavy growth of Staphylococcus aureus and skin flora. The patient's culture results show heavy growth of Staphylococcus aureus, and while neomycin is expected to have activity against this bacterium, its use is associated with several limitations, including the risk of contact dermatitis, which has a prevalence of 13% to 30% on patch testing of patients with chronic otitis externa 1.
Instead, consider using fluoroquinolone ear drops like ciprofloxacin or ofloxacin, which provide better coverage against Staphylococcus aureus. These should be administered as 3-4 drops in the affected ear twice daily for 7-10 days. Key considerations when selecting a treatment include:
- Ensuring the tympanic membrane is intact, as some ear drops are contraindicated with perforations
- Monitoring for signs of contact dermatitis or other adverse reactions
- Considering culture-directed oral antibiotics or specialist referral if symptoms do not improve within 48-72 hours of appropriate treatment
It is also important to note that neomycin resistance is increasingly common, which may further limit its effectiveness in this case 1. Additionally, the patient's ear canal and tympanic membrane should be reexamined to detect any unrecognized foreign body, perforated tympanic membrane, or middle ear disease, which could impact treatment selection and outcomes 1.
From the FDA Drug Label
Topical preparations containing framycetin, neomycin, sulfacetamide, gramicidin or chloramphenicol are expected to have activity against S. aureus. The patient has a heavy growth of Staphylococcus aureus and skin flora in the right ear.
- Neomycin is expected to have activity against S. aureus. However, Kencomb drops contain neomycin, and the use of neomycin can induce permanent sensorineural hearing loss due to cochlear damage. It is crucial to weigh the benefits against the potential risks, especially the risk of hearing loss. Considering the potential risks, giving this patient Kencomb (neomycin) drops may not be entirely okay without close clinical observation and monitoring for signs of sensitization or irritation 2.
From the Research
Patient Treatment
The patient has a right ear infection with heavy growth of Staphylococcus aureus and skin flora. The question is whether it is okay to give this patient Kencomb (neomycin) drops.
Effectiveness of Neomycin
- Neomycin is expected to have activity against S. aureus, as stated in the patient's culture results.
- However, studies have shown that the susceptibility of pathogens to neomycin and polymyxin B has been declining over time 3.
- A study found that the minimum inhibitory concentrations (MICs) of neomycin and polymyxin B for major pathogens, including P. aeruginosa and S. aureus, increased markedly between 1995-1996 and 1999-2000 3.
- Another study compared the efficacy of neomycin/polymyxin B/hydrocortisone with ofloxacin for the treatment of otitis externa and found that the clinical cure rate for neomycin/polymyxin B/hydrocortisone was lower (87%) than for ofloxacin (93%) 3.
Alternative Treatments
- Topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones are the treatment of choice in uncomplicated cases of otitis externa 4.
- A study found that topical 0.2% ciprofloxacin solution in single-dose containers was effective and well tolerated in patients with chronic suppurative otitis media 5.
- Another study found that topical administration of ciprofloxacin improved the results compared to oral administration in active infection of chronic disease of the middle ear 6.
Conclusion Not Provided
As per the instructions, no conclusion will be provided. The information above is based on the available evidence and justifications.