Page 1438 - Cote clinical veterinary advisor dogs and cats 4th

730 Otitis Externa

Topical Otic Treatments for Otitis Externa—cont’d
VetBooks.ir Otic Exam Rods, Cocci, and Yeast or PRODUCT OPTIONS FOR ORGANISMS CYTOLOGICALLY DETECTED

Cocci and Yeast or Cocci Only
Yeast
Rods and Yeast or Rods
Treatment of Chronic Otitis Externa
Minimal or no stenosis or • Baytril (2.27% injectable)/ • Baytril (2.27% injectable)/Cort/Astrin • Claro otic solution
hyperplasia; second-line miconazole 1% lotion/ solution (1 : 4 vol. conc.), extralabel • EasOtic suspension
†
topical otic medication, active dexamethasone (2 mg/mL • Baytril (2.27% injectable)/ dexamethasone • MalAcetic Ultra otic flush*
ingredients based on cytologic injectable) solution (1 : 1 : 1 (2 mg/mL injectable)/ saline solution † • TrizEDTA flush*
†
evaluation of otic exudate vol. conc.), extralabel (1 : 1 : 1 vol. conc.), extralabel • Miconazole 1% lotion †
containing any vehicle • Posatex suspension • Baytril otic emulsion • Miconazole 1% lotion/dexamethasone (2 mg/mL
†
• Posatex suspension injectable) (1 : 1 vol. conc.), extralabel
• Mometamax suspension
• Osurnia otic gel
• Otomax ointment
• Tresaderm solution*
• TrizUltra + Keto flush*
• T8 Keto flush*
Moderate to severe stenosis • Baytril (2.27% injectable)/ • Baytril (2.27% injectable): Cort/Astrin • Claro otic solution
†
or hyperplasia; second-line miconazole 1% lotion/ solution (1 : 4 vol. conc.), extralabel • MalAcetic Ultra otic flush*
topical otic medication, active dexamethasone (2 mg/mL • Baytril (2.27% injectable)/ dexamethasone • TrizEDTA flush*
†
ingredients based on cytologic injectable) solution (1 : 1 : 1 (2 mg/mL injectable)/ saline solution † • Miconazole 1% lotion †
evaluation of otic exudate vol. conc.), extralabel (1 : 1 : 1 vol. conc.), extralabel • Miconazole 1% lotion/dexamethasone (2 mg/mL
†
containing solution, lotion, • Baytril otic emulsion injectable) (1 : 1 vol. conc.), extralabel
emulsion, flush, or gel vehicle • Osurnia otic gel
*Products for use in cats.
† Products not specifically for use in the ear.
-Active ingredients of otic products:
†
Baytril (2.27% injectable)/dexamethasone (2 mg/mL injectable)/saline solution (1 : 1 : 1 vol. conc.), extralabel
†
Baytril (2.27% injectable)/miconazole 1% lotion/dexamethasone (2 mg/mL injectable) solution (1 : 1 : 1 vol. conc.), extralabel
†
Baytril (2.27% injectable): Cort/Astrin solution : (1 : 4 vol. conc.), extralabel
Baytril otic emulsion: enrofloxacin, silver sulfadiazine
Claro otic solution: florfenicol, terbinafine, mometasone furoate
EasOtic suspension: gentamicin sulfate, miconazole, hydrocortisone aceponate
MalAcetic Ultra otic flush*: ketoconazole, acetic acid, boric acid, hydrocortisone
Mal-A-Ket plus TrizEDTA flush*: chlorhexidine gluconate, ketoconazole, tris-EDTA
Miconazole 1% lotion †
†
Miconazole 1% lotion/dexamethasone (2 mg/mL injectable) (1 : 1 vol. conc.), extralabel
Mometamax suspension: gentamicin sulfate, clotrimazole, mometasone furoate
Osurnia otic gel: florfenicol, terbinafine, betamethasone acetate
Otomax ointment: gentamicin sulfate, clotrimazole, betamethasone valerate
Posatex suspension: orbifloxacin, posaconazole, mometasone furoate
Surolan suspension: miconazole, polymyxin B, prednisolone
T8 Keto flush*: tris-EDTA, ketoconazole
Tresaderm solution*: neomycin sulfate thiabendazole, dexamethasone
TrizUltra + Keto flush*: ketoconazole, tris-EDTA
Additional Topical Medications for Acute or Chronic Otitis Externa Chronic Treatment
In end-stage otitis, the ear canal is completely or
• Ear cleaning and drying agents
• Recommended for at-home cleaning nearly completely occluded, often accompanied
• May be used daily or as needed by palpable fibrosis/mineralization, and is non-
• Ceruminolytic agent responsive to treatment with glucocorticoids.
• Used for in-clinic anesthetic flush or at-home cleaning Treatment at that point is surgical total ear
• Ceruminolytic agents are considered ototoxic until proved otherwise canal ablation and bulla osteotomy.
• Non-ototoxic product option
• Cerumene* (25% squalene) Possible Complications
• Glucocorticoids Para-aural abscesses, draining tracts, infectious
• Used if specific otic medication for infection does not contain a glucocorticoid otitis media, and otitis interna
• Used for management of allergic otitis externa
• Product options Recommended Monitoring
• Cort/Astrin* (Burow’s solution, 1% hydrocortisone)
• Synotic (0.01% fluocinolone acetonide, 60% dimethyl sulfoxide) An otoscopic exam along with otic cytology
• Tris-EDTA should be performed by the veterinarian every
• Recommend using a tris-EDTA–containing product any time the otic infection is due to rod (gram- 2 to 4 weeks to monitor improvement in the
negative) bacteria clinical signs of the otitis and resolution of
• Pre-treat before using a specific otic medication for the bacterial infection the infection.
• Product options
• Mal-A-Ket plus TrizEDTA flush*: chlorhexidine gluconate, ketoconazole, tris-EDTA
• TrizUltra + Keto flush*: ketoconazole, tris-EDTA PROGNOSIS & OUTCOME
• T8 Keto flush*: tris-EDTA, ketoconazole
• TrizChlor flush*: chlorhexidine, tris-EDTA If the primary cause of the otitis externa is
identified and managed, the prognosis is good.
*Products for use in cats. Causative primary factors for otitis externa must
† Products not specifically for use in the ear.
be evaluated or the condition is likely to become
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