|Volume 6 Issue 7 Published - 14:00 UTC 08:00 EST 7-Jan-2004 Next Update - 14:00 UTC 08:00 EST 8-Jan-2004||Editor: Susan K. Boyer, RN
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Journal Watch: Clinical comparison of three common treatments of acute otitis externa in primary care
In a Journal Watch review of van Balen FAM et al. Clinical efficacy of three common treatments in acute otitis externa in primary care: Randomized controlled trial. BMJ 2003 Nov 22; 327:1201-3., Dr. Keith I. Marton commented that unless physicians are aware that a patient is allergic to an antibiotic, or that antibiotic resistant organisms are present, it is reasonable to choose between acetic acid/steriod or antibiotic/steriod ear drops to treat otitis externa. Both combinations are generally effective. Several types of eardrops are available to treat acute otitis externa. They generally contain either acetic acid or antibiotics, with or without steroids. All are more effective than placebo for this condition, but which is best?
Researchers in the Netherlands randomized 213 adults with acute otitis externa to eardrops that contained acetic acid alone, acetic acid plus a steroid (triamcinolone), or antibiotics (neomycin and polymyxin B) plus a steroid (dexamethasone). Patients were treated until cured or for 21 days, whichever came first.
The median duration of patient-reported symptoms was 8 days with acetic acid alone, 7 days with acetic acid plus steroid, and 6 days with antibiotics plus steroid. Cure rates with acetic acid alone at 14 days (56%) and 21 days (62%) were significantly lower than rates either with acetic acid plus steroid (75% and 89%, respectively) or with antibiotics plus steroid (82% and 86%, respectively). Similarly, symptom recurrence between 21 days and 42 days was more common with acetic acid alone (45%) than with acetic acid plus steroid (26%) or antibiotics plus steroid (21%).
At the time of publication, the full text of the original article was available free of charge.
Review appears in: Journal Watch January 6, 2004
MEDLINE Abstract: Clinical efficacy of three common treatments in acute otitis externa in primary care: Randomized controlled trial.
van Balen FA, Smit WM, Zuithoff NP, Verheij TJ.
Julius Center for Health Sciences and Primary Care, PO Box 80560, 3508 AB Utrecht, Netherlands. firstname.lastname@example.org
OBJECTIVE: To compare the clinical efficacy of ear drops containing acetic acid, corticosteroid and acetic acid, and steroid and antibiotic in acute otitis externa in primary care. DESIGN: Randomized controlled trial. SETTING: 79 general practices, Netherlands. PARTICIPANTS: 213 adults with acute otitis externa. MAIN OUTCOME MEASURES: Primary outcome: duration of symptoms (days) according to patient diaries. Secondary outcome: cure rate according to general practitioner completed questionnaires and recurrence of symptoms between days 21 and 42. RESULTS: Symptoms lasted for a median of 8.0 days (95% confidence interval 7.0 to 9.0) in the acetic acid group, 7.0 days (5.8 to 8.3) in the steroid and acetic acid group, and 6.0 days (5.1 to 6.9) in the steroid and antibiotic group. The overall cure rates at seven, 14, and 21 days were 38%, 68%, and 75%, respectively. Compared with the acetic acid group, significantly more patients were cured in the steroid and acetic acid group and steroid and antibiotic group at day 14 (odds ratio 2.4, 1.1 to 5.3, and 3.5, 1.6 to 7.7, respectively) and day 21 (5.3, 2.0 to 13.7, and 3.9, 1.7 to 9.1, respectively). Recurrence of symptoms between days 21 and 42 occurred in 29% (50/172) of patients and was seen significantly less in the steroid and acetic acid group (0.3, 0.1 to 0.7) and steroid and antibiotic group (0.4, 0.2 to 1.0) than in the acetic acid group. CONCLUSIONS: Ear drops containing corticosteroids are more effective than acetic acid ear drops in the treatment of acute otitis externa in primary care. Steroid and acetic acid or steroid and antibiotic ear drops are equally effective.