S218 – Treatment Failures in Acute Otitis Externa

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P148-P148
Author(s):  
Peter S Roland ◽  
G. Michael Wall ◽  
Celeste McLean ◽  
David Stroman
Keyword(s):  
Treatment Failure ◽  
Failure Rate ◽  
Otitis Externa ◽  
Clinical Signs ◽  
Polymyxin B ◽  
Significant Difference ◽  
Initiation Of Therapy ◽  
Major Pathogens ◽  
Ear Drops

Objectives Understand treatment failure rates of cipro-floxacin/steroid- vs. Neomycin/Polymyxin B/Hydrocortisone (NPH)-containing ear drops against the two major pathogens in acute otitis externa (AOE), Pseudomonas aeruginosa and Staphylococcus aureus. Methods Retrospective analysis of clinical studies involving NPH versus either 0.3% ciprofloxacin/0.1% dexamethasone (CDX)(2 trials, 1998–1999) or 0.2% ciprofloxacin/1% hydrocortisone (CHC) (3 trials, 1994–1996) in the treatment of patients diagnosed with AOE. Patients were randomized to treatment with either CHC, CDX (both bid) or NPH (tid), 3–4 drops per ear for 7 days. Microbiology specimens were collected from infected ears prior to the initiation of therapy, and at exit visit if there were any clinical signs of infection. Results The therapy failure rate of P. aeruginosa for CDX and CHC was 6.7% (20/300) versus NPH at 12.8% (39/306), p = 0.017. The failure rate of S. aureus for CDX and CHC was 9.2% (6/65) vs. NPH at 8.3% (4/48), p = 0.87. In no instance of treatment failure was the pre-therapy pathogen resistant in vitro to the antibiotics used to treat the infection. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B. Conclusions Based on data from 5 separate AOE clinical trials, ciprofloxacin-containing ear drops, CDX and CHC, provided significantly greater eradication (93.3%) of P. aeruginosa compared to NPH ear drops (87.2%). There was no significant difference in the rate of eradication of S. aureus between the two groups of ear drops.

scholarly journals A Comparative Study on Efficacy of Polymyxin B, Neomycin and Polymyxin B, Neomycin, Hydrocortisone in the Treatment of Otitis Externa at Nepal Medical College and Teaching Hospital, Kathmandu

2017 ◽  
Vol 2 (2) ◽  
pp. 162-167
Author(s):  
Mayuri Gupta ◽  
S Aryal
Keyword(s):  
Teaching Hospital ◽  
Otitis Externa ◽  
Clinical Signs ◽  
Polymyxin B ◽  
Medical College ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Cure Rates

IntroductionAcute otitis externa (AOE) is a common but preventable ear condition. Tenderness with movement of the tragus or pinna is a classic feature of otitis Externa. Polymyxin B, neomycin, hydrocortisone preparations are the choice for first-line therapy when the tympanic membrane is intact. This study atiempted to compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.ObjectiveTo compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.MethodologyTo evaluate the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa, a hospital based, randomized, prospective study was conducted in Nepal Medical College and Teaching Hospital (NMCTH), Atiarkhel, Kathmandu from August 2012 to May 2014. 70 outpatients suffering from otitis Externa who met the inclusion and exclusion criteria were included. Patients were randomized into group A and group B with lotiery system. Odd number patients were included in group A and even number patients in group B. Group A patients received pack soaked with ribbon gauge in polymyxin B, neomycin ointment and Group B patients received pack soaked with ribbon gauge in polymyxin B, neomycin, hydrocortisone ointment. The patients were called for follow up after 48 hours and 96 hours to assess the improvement on the basis of tragal and circumduction tenderness either present or absent (present 1 or absent 2). A decrease in the clinical signs and symptoms (i.e. tragal and circumduc_on tenderness) was noted. Absence of pain was considered as clinically cured.ResultsIn comparison to polymyxin B, neomycin group, hydrocortisone group exhibited statistically significant effectiveness after 48 hours of treatment (p<0.05), but in cure rates after 96 hours, no statistical significant difference was observed between two groups (p>0.05).ConclusionPolymyxin B, neomycin, hydrocortisone group showed higher and faster cure rates than polymyxin B, neomycin group in the treatment of otitis Externa at 48 hours follow up. Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 162-167 

scholarly journals Pathogenicity of Different Baboon Herpesvirus Papio 2 Isolates Is Characterized by either Extreme Neurovirulence or Complete Apathogenicity

2003 ◽  
Vol 77 (20) ◽  
pp. 10731-10739 ◽  
Author(s):  
Kristin M. Rogers ◽  
Katie A. Ealey ◽  
Jerry W. Ritchey ◽  
Darla H. Black ◽  
R. Eberle
Keyword(s):  
Phylogenetic Analyses ◽  
Clinical Signs ◽  
Tissue Destruction ◽  
Safety Level ◽  
Tissue Samples ◽  
Significant Difference ◽  
Intergenic Regions ◽  
Monkey B Virus

ABSTRACT In comparisons of the pathogenicity of simian alphaherpesviruses in mice, two isolates of the baboon virus HVP2 were nearly as lethal as monkey B virus, a biological safety level 4 agent (J. W. Ritchey, K. A. Ealey, M. Payton, and R. Eberle, J. Comp. Pathol. 127:150-161, 2002). To confirm these results, mice were inoculated intramuscularly with 105 PFU of HVP2 isolates obtained from different baboon subspecies and primate centers. Some of the HVP2 isolates (6 of 13) caused paralysis and death in the mice, while 7 of 13 HVP2 isolates produced no clinical signs of disease. The apathogenic HVP2 isolates (HVP2ap) induced only low levels of serum antiviral immunoglobulin G relative to levels observed in sera from mice infected with the neurovirulent isolates of HVP2 (HVP2nv). Histological examination of tissues from mice inoculated with HVP2nv isolates showed extensive neural tissue destruction, while mice infected with HVP2ap isolates showed no lesions. Tissue samples collected at 48-h intervals postinfection suggested that HVP2ap isolates failed to replicate at the site of inoculation. There was no significant difference in the in vitro replication, plaque size, or cytopathic effect morphology of HVP2ap versus HVP2nv isolates. While HVP2 isolates replicated better in Vero monkey kidney cells than in murine L cells, plaquing efficiency of individual isolates did not correlate with the dichotomous pathogenic properties seen in mice. Phylogenetic analyses of both coding and intergenic regions (US4-6) of the HVP2 genome separated isolates into two distinct clades that correlated with the two in vivo virulence phenotypes. Taken together, these results demonstrate that two subtypes of HVP2 exist that are very closely related but differ dramatically in their ability to cause disease in a murine model.

scholarly journals Risk Factors for Treatment Failure of Polymyxin B Monotherapy for Carbapenem-Resistant Klebsiella pneumoniae Infections

2013 ◽  
Vol 57 (11) ◽  
pp. 5394-5397 ◽  
Author(s):  
Yanina Dubrovskaya ◽  
Ting-Yi Chen ◽  
Marco R. Scipione ◽  
Diana Esaian ◽  
Michael S. Phillips ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Renal Insufficiency ◽  
Treatment Failure ◽  
Clinical Cure ◽  
Polymyxin B ◽  
Antimicrobial Treatment ◽  
Carbapenem Resistant

ABSTRACTPolymyxins are reserved for salvage therapy of infections caused by carbapenem-resistantKlebsiella pneumoniae(CRKP). Though synergy has been demonstrated for the combination of polymyxins with carbapenems or tigecycline,in vitrosynergy tests are nonstandardized, and the clinical effect of synergy remains unclear. This study describes outcomes for patients with CRKP infections who were treated with polymyxin B monotherapy. We retrospectively reviewed the medical records of patients with CRKP infections who received polymyxin B monotherapy from 2007 to 2011. Clinical, microbiology, and antimicrobial treatment data were collected. Risk factors for treatment failure were identified by logistic regression. Forty patients were included in the analysis. Twenty-nine of 40 (73%) patients achieved clinical cure as defined by clinician-documented improvement in signs and symptoms of infections, and 17/32 (53%) patients with follow-up culture data achieved microbiological cure. End-of-treatment mortality was 10%, and 30-day mortality was 28%. In a multivariate analysis, baseline renal insufficiency was associated with a 6.0-fold increase in clinical failure after adjusting for septic shock (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 1.22 to 29.59). Breakthrough infections with organisms intrinsically resistant to polymyxins occurred in 3 patients during the treatment. Eighteen of 40 (45%) patients developed a new CRKP infection a median of 23 days after initial polymyxin B treatment, and 3 of these 18 infections were polymyxin resistant. The clinical cure rate achieved in this retrospective study was 73% of patients with CRKP infections treated with polymyxin B monotherapy. Baseline renal insufficiency was a risk factor for treatment failure after adjusting for septic shock. Breakthrough infections with organisms intrinsically resistant to polymyxin B and development of resistance to polymyxin B in subsequent CRKP isolates are of concern.

scholarly journals Current Thoughts on the Treatment of Malassezia in Canine Otitis Externa

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Mary Fraser
Keyword(s):  
Otitis Externa ◽  
Current Knowledge ◽  
Chelating Agent ◽  
Controlled Trials ◽  
Double Blind ◽  
Malassezia Pachydermatis ◽  
Pubmed Database ◽  
Significant Difference ◽  
Randomised Controlled

<p>Otitis externa is a commonly diagnosed disorder of canine patients (Rosser, 2004) and can be caused by a number of different factors including infection, allergy, foreign bodies and breed/ear conformation. Malassezia pachydermatis is a yeast which is found as a commensal on canine skin, but may also contribute to the development and perpetuation of the condition.</p><p>The aim of this paper was to assess current knowledge and approaches to the treatment of M. pachydermatis when found to be present in cases of canine otitis externa.</p><p>A literature search was carried out using PubMed database. Search terms Malassezia, dogs / canine, otitis and therapy/treatment/therapeutics were utilised. This identified 26 results from 2005 - 2015. Examination of these papers focussed the review to 11 papers that were clinically relevant. The excluded papers were either concerned with laboratory storage/growth of M. pachydermatis, did not include therapy of the condition, or focussed on other skin conditions.</p><p>Of the 11 papers deemed relevant to this study, only three were double blind, randomised controlled trials (Rougier et al, 2005, Bensignor &amp; Grandemange, 2006, Hensel et al, 2009); one paper was a review of current literature relating to dermatology, including otitis externa (Bond, 2010) and the remainder were focussed on in vitro work with M. pachydermatis.</p><p>Many different therapeutics were used, namely thiabendazole, amphotericin B, itraconazole, ketoconazole, clotrimazole, miconazole, nystatin, chelating agents and various ear cleaners.</p><p>Within the controlled trials, a chelating agent was shown to improve therapeutic effectiveness of topical medication, combination therapy (antifungal, antibacterial and anti-inflammatory agents) was more effective than antifungal agent alone and no significant difference was noted when comparing combination therapies. A clear difference was found between different ear cleaners.</p><p>This review highlights the variety of different medications that can be used in the treatment of Malassezia otitis externa and the need for a greater number of robust clinical trials.</p><p>Find out more about <a href="http://www.girlingandfraser.co.uk/page4.htm" target="_blank">Mary</a>.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals In vitro evaluation of the antimicrobial activity and diffusion capacity of solutions used for canine ear cleaning

2021 ◽  
Vol 10 (10) ◽  
pp. e539101019285
Author(s):  
Carolina Boesel Scherer ◽  
Larissa Silveira Botoni ◽  
Kelly Moura Keller ◽  
Fernanda Morcatti Coura ◽  
Antônio Último de Carvalho ◽  
...  
Keyword(s):  
Antimicrobial Activity ◽  
Salicylic Acid ◽  
Lactic Acid ◽  
Boric Acid ◽  
Propylene Glycol ◽  
Otitis Externa ◽  
Clinical Signs ◽  
Diffusion Capacity ◽  
And Diffusion

Otitis is a common condition among dogs and requires appropriate treatment. Given the importance of the otitis externa and the use of products to combat this condition, this study evaluated the in vitro antimicrobial abilities of six commercial ear cleaners solutions (EC1 to EC6) and solutions of 3% boric acid, 3% lactic acid, 0.11% salicylic acid, 0.5% chlorhexidine, and 3% propylene glycol against Staphylococcus spp., Pseudomonas spp., Proteus spp., and Malassezia spp. The in vitro diffusion capacity in synthetic cerumen was also assessed. Dogs with clinical signs of otitis externa were selected and samples were collected from the external ear canals. The microbiological study was performed to identify the microorganisms from samples collected and the microorganisms isolated were used in the study. One ceruminolytic for human use and five commercial solutions used for canine ear cleaning were selected based on the diversity of the components used in each formula. The results show a variation of antimicrobial activity and diffusion capacity ear cleaners and its compounds. Lactic acid, chlorhexidine, EC1, EC2, EC4, and EC5 showed the best results for microbiological growth inhibition; boric acid, salicylic acid, propylene glycol and EC6 had little or no effect on microorganism growth. The ECs tested demonstrated diffusion capacity using the SSC. EC1 was the solution with the most significant responses, both as an antimicrobial agent and with regards to diffusion capacity. Among the commercial veterinary products tested, EC4 was found to have the best results.

Effects of intramammary inoculation ofLactobacillus perolensCRL1724 in lactating cows’ udders

2011 ◽  
Vol 79 (1) ◽  
pp. 84-92 ◽  
Author(s):  
Ignacio D Frola ◽  
Matías S Pellegrino ◽  
María C Espeche ◽  
José A Giraudo ◽  
María EF Nader-Macias ◽  
...  
Keyword(s):  
Bovine Mastitis ◽  
Clinical Signs ◽  
Probiotic Properties ◽  
Lactating Cows ◽  
Cell Counts ◽  
Major Pathogens ◽  
Adhesion Index ◽  
Teat Canal

Bovine mastitis is the most important infectious disease on dairy farms. Conventional antibiotic therapy is often unsatisfactory and alternative treatments are continually under investigation.Lactobacillus (Lb.) perolensCRL 1724 andLactobacillus plantarumCRL 1716 were previously isolated from milk of dairy cows and selected according to their potential probiotic properties. In the present work the in-vitro capacity ofLactobacillusstrains to adhere to bovine teat canal epithelial cells (BTCEC) and to inhibit and co-aggregate 14 mastitis-causing pathogens (MCPs) was investigated. The effect ofLb. perolensCRL 1724 after intramammary inoculation in lactating cows was evaluated through determination of clinical signs of mastitis, milk appearance, somatic cell counts andLb. perolensCRL 1724 recovery from milk.Lb. perolensCRL 1724 was able to inhibit 12 of 14 MCPs (85·7%) in vitro, especially those considered to be major pathogens. In addition,Lb. perolensCRL 1724 co-aggregated with all of them.Lb. plantarumCRL 1716 was able to inhibit 7 of 14 MCPs (50%) in vitro and showed co-aggregation ability similar toLb. perolensCRL 1724.Lb. perolensCRL 1724 showed a higher efficacy of adhesion to BTCEC (values of percentage of adhesion and adhesion index of 75% and 14·4, respectively) thanLb. plantarumCRL 1716 (37% and 7·4, respectively).Lb. perolensCRL 1724 was recovered from all mammary quarters and no clinical signs or teat damage were observed after the inoculation of 106cfu/ml. The udders presented a normal aspect and there were no changes in the appearance of the milk. The results obtained will serve as the basis for further trials to evaluate the potential ofLb. perolensCRL 1724 to be included in a non-antibiotic formulation for the prevention of bovine mastitis.

Tympanostomy Tubes and Otic Suspensions: Do They Reach the Middle Ear Space?

2000 ◽  
Vol 122 (3) ◽  
pp. 330-333 ◽  
Author(s):  
Richard L. Hebert ◽  
Michael L. Vick ◽  
Geoffrey E. King ◽  
John P. Bent
Keyword(s):  
Middle Ear ◽  
Tap Water ◽  
Human Head ◽  
Polymyxin B ◽  
Positive Test ◽  
Positive Test Result ◽  
Significant Difference ◽  
Tympanostomy Tubes ◽  
Test Result

The treatment of patients with tympanostomy tubes (TTs) and otorrhea with medicated otic suspensions is well known, but confirmation of penetration into the middle ear is difficult. To address this question, we created an in vitro model of the human head and ear and then tested it with 5 different types of liquid exposure: tap water, soapy water, polymyxin B sulfate (Cortisporin), tobramycin and dexamethasone (TobraDex), and ciprofloxacin (Cipro) suspensions. A positive test result corresponded to liquids entering the middle ear through the TT. No positive test result was elicited with tap water (0/20), but soapy water did enter the middle ear (10/40) and was statistically significant ( P = 0.0112). Without the use of slight tragal pressure, Cortisporin, TobraDex, and Cipro drops did not consistently pass through the TT (0/20, 1/25, 1/25). By placing the drops with the addition of tragal pressure, a statistically significant difference was obtained for each solution (20/20, 20/20, and 20/20, respectively [ P < 0.0001]). We conclude that with a clean external auditory canal, patent TT, and no middle ear fluid, medicated otic suspensions enter the middle ear only when combined with slight tragal pressure.

Low rate of azole resistance in cases of avian aspergillosis in Germany

2020 ◽  
Vol 58 (8) ◽  
pp. 1187-1190 ◽  
Author(s):  
Amelia E Barber ◽  
Sandra Scheufen ◽  
Grit Walther ◽  
Oliver Kurzai ◽  
Volker Schmidt
Keyword(s):  
Respiratory Tract ◽  
Treatment Failure ◽  
Molecular Species ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Azole Resistance ◽  
Molecular Species Identification ◽  
Avian Aspergillosis ◽  
Low Rate

Abstract Aspergillosis is the most common fungal disease of the avian respiratory tract. Due to delayed diagnosis and treatment failure, the outcome of these infections is often poor. We investigate 159 cases of avian aspergillosis among captive birds in Germany to define clinical features as well as the frequency of in vitro triazole resistance. Adult birds were more likely to present with clinical signs compared to juvenile birds, and dyspnoea was the most common clinical sign, present in 53% of birds. Molecular species identification indicated that all infections were caused by Aspergillus fumigatus. Only one of 159 independent isolates was azole resistant.

scholarly journals IN VITRO ANTIMICROBIAL ACTIVITY OF COCONUT SHELL LIQUID SMOKE AGAINST Candida albicans AND Lactobacillus acidophilus ATTRIBUTING TO ENDODONTIC TREATMENT FAILURE

2021 ◽  
Vol 10 (1) ◽  
pp. 35-40
Author(s):  
Isniya Nosartika ◽  
Nadia Hardini ◽  
Tyas Prihatiningsih
Keyword(s):  
Antimicrobial Activity ◽  
Treatment Failure ◽  
Root Canal ◽  
Endodontic Treatment ◽  
Coconut Shell ◽  
Dilution Method ◽  
Liquid Smoke ◽  
Significant Difference ◽  
Post Hoc

L. acidophilus bacteria and C. albicans fungi are the most common microorganisms isolated from the oral cavity of patients suffering from post-treatment of root canal endodontic infections. Chlorophenol Camphor menthol (ChM) is one of the antimicrobials used for root canal sterilizer but it still has many flaws. Coconut shell liquid smoke (CS-LS) is a natural product that has an antimicrobial activity and non-toxic chemical compounds for humans. This study aims at determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of L. acidophilus bacteria and C. Albicans fungi and comparing the antimicrobial activity between CS-LC with commercial root canal sterilization. The MIC and MBC of CS-LS were measured using 10 different concentrations ranging from 10-100%. MIC was determined by the broth dilution method. All concentration was cultured on each agar media to determine its MBC. The data were analyzed using the comparative test of Kruskall-Wallis with post-hoc Mann-Whitney. MIC and MBC of C. albicans were 10% of CSLS. Meanwhile, L. acidophilus has the MIC with a 50% concentration of CSLS and MBC with a 60% concentration of CS-LS. No significant difference in CS-LS and ChKM was found. Thus, CS-LS has a potential for endodontic treatment failure. Further research should be conducted to know other potential uses of CS-LS in dentistry.

scholarly journals Effects of polymyxin B on clinical signs, serum TNF-α, haptoglobin and plasma lactate concentrations in experimental endotoxaemia in sheep

2018 ◽  
Vol 62 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Ali Hajimohammadi ◽  
Khalil Badiei ◽  
Parviz Kheibari ◽  
Meherdad Pourjafar ◽  
Aliasghar Chalmeh
Keyword(s):  
Intravenous Administration ◽  
Clinical Signs ◽  
Polymyxin B ◽  
Positive Control ◽  
Positive Control Group ◽  
Control Group ◽  
Plasma Lactate ◽  
Serum Haptoglobin ◽  
Tnf Α ◽  
Significant Difference

AbstractIntroductionThe experiment evaluated the effects of intravenous administration of polymyxin B on experimental endotoxaemia in sheep.Material and MethodsTwenty clinically healthy fat-tailed sheep were randomly divided into: a group treated with 6,000 U/kg of polymyxin B, a group at 12,000 U/kg, and positive and negative controls. Endotoxaemia was induced by intravenous administration of lipopolysaccharide (LPS) fromE.coliserotype O55:B5 at 0.5 μg/kg. polymyxin was infused intravenously along with 2.5 L of isotonic intravenous fluids at 20 mL/kg/h. The positive control group received LPS and 2.5 L of isotonic fluids, the negatives receiving just 2.5 L of isotonic fluids. Clinical signs were evaluated before and at 1.5, 3, 4.5, 6, 24, and 48 h after LPS administration. Blood was also sampled at the denoted hours and serum haptoglobin, tumour necrosis factor-α (TNF-α), and plasma lactate concentrations were assayed.ResultsThe serum concentration of TNF-α in the positive control group increased significantly up to 48 h after LPS administration. The concentration of TNF-α was significantly different from those of the polymyxin B and positive control groups from 3 to 48 h; also, the concentrations of haptoglobin at different times in the polymyxin groups were lower than those of the positive control group and were significant at hours 3 to 48 (P < 0.05). Following the LPS administration, haptoglobin and TNF-α concentrations changed without significant difference between the two polymyxin B groups.ConclusionPolymyxin B (6,000 U/kg) restrained blood lactate concentrations. Furthermore, it significantly improved the clinical signs in endotoxaemic animals, including rectal temperature and heart and respiratory rates. Polymyxin B may be an antiendotoxic in fat-tailed sheep.

Sign in / Sign up

Export Citation Format

Share Document