Dexamethasone + Neomycin + Glacial Acetic Acid
Indications
This combination ear spray is indicated for the treatment of otitis externa.
Pharmacology
Neomycin sulfate is an established antibiotic with a well characterised broad spectrum of activity. Dexamethasone is a well established topical anti-inflammatory steroid. Acetic acid functions to produce a low pH to assist in the control of bacterial infection.
Dosage & Administration
Adults (including the elderly) and children 2 years of age and over: One metered dose (60 mg) to be administered directly into each affected ear three times daily. Treatment should be continued until two days after symptoms have disappeared. Discontinue treatment if there is no clinical improvement after 7 days.
Infants and neonates (under 2 years of age): This ear spray is not suitable for infants and neonates.
Shake the bottle well before use. Before first use, press actuator down several times to obtain a fine spray. Each press then delivers one metered dose. Do not inhale the spray. Administer spray directly by gently placing nozzle tip into ear opening and pressing down once on the actuator. Use within one month of first use. If there is a period of more than one week since last use, press actuator down a few times before using again.
Infants and neonates (under 2 years of age): This ear spray is not suitable for infants and neonates.
Shake the bottle well before use. Before first use, press actuator down several times to obtain a fine spray. Each press then delivers one metered dose. Do not inhale the spray. Administer spray directly by gently placing nozzle tip into ear opening and pressing down once on the actuator. Use within one month of first use. If there is a period of more than one week since last use, press actuator down a few times before using again.
Contraindications
Hypersensitivity to the active substances or to any of the excipients of this ear drop. The product should not be used in patients where a perforated tympanic membrane has been diagnosed or is suspected or where a tympanostomy tube (grommet) is in situ. The product should not be used in infants and neonates under 2 years of age.
Side Effects
Eye disorders: Blurred vision has been reported with corticosteroid use; for dexamethasone, the frequency is not known
Skin and subcutaneous tissue disorders: Some patients may experience a transient stinging or burning sensation for the first few days of treatment. Skin hypersensitivity reactions (immediate and delayed) leading to irritation, burning, stinging, itching and dermatitis.
Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.
Skin and subcutaneous tissue disorders: Some patients may experience a transient stinging or burning sensation for the first few days of treatment. Skin hypersensitivity reactions (immediate and delayed) leading to irritation, burning, stinging, itching and dermatitis.
Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.
Pregnancy & Lactation
Pregnancy: There are no adequate data on the use of dexamethasone in pregnant women. Studies in animals have shown topical administration of corticosteroids to cause reproductive toxicity. There is a risk of foetal ototoxicity if aminoglycoside antibiotics preparations are administrated during pregnancy. This ear spray is not recommended during pregnancy.
Lactation: No reports describing the use of neomycin or dexamethasone during human lactation are available and the effects on the nursing infant from exposure to the drug in milk are unknown. Maternal use of topical preparations generally carries less risk than a systemically administered drug. A risk to the breast-fed child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from this ear spray therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Lactation: No reports describing the use of neomycin or dexamethasone during human lactation are available and the effects on the nursing infant from exposure to the drug in milk are unknown. Maternal use of topical preparations generally carries less risk than a systemically administered drug. A risk to the breast-fed child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from this ear spray therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Precautions & Warnings
Product use should be discontinued, and medical advice sought where appropriate, if irritation or rash occurs, or if the condition worsens or does not improve within 7 days.
When otitis externa is treated topically with preparations containing aminoglycosides, in patients who have a perforation of the tympanic membrane, there is an increased risk of drug induced deafness. It is therefore important to ensure that there is no perforation in such patients.
It is important to exclude chronic alternate diagnoses, including chronic otitis media, before treatment is commenced.
Treatment with corticosteroid/antibiotic combinations should not be continued for more than 7 days in the absence of any clinical improvement, since prolonged use may lead to occult extension of infections due to the masking effect of the steroid.
In children there is a theoretical risk that sufficient steroid may be absorbed to cause adrenal suppression, with prolonged use increasing this risk of adrenal suppression in children.
Prolonged use may also lead to skin sensitisation and the emergence of resistant organisms.
Due to potentially immature renal function in children toxicity may develop, thus caution is warranted when administering neomycin in this age group.
Aminoglycoside antibiotics may cause irreversible, partial or total deafness when given systemically or when applied topically to open wounds or damaged skin. This effect is dose related and is enhanced by renal or hepatic impairment. This possibility should be considered when high doses or prolonged treatment is given to small children.
When otitis externa is treated topically with preparations containing aminoglycosides, in patients who have a perforation of the tympanic membrane, there is an increased risk of drug induced deafness. It is therefore important to ensure that there is no perforation in such patients.
It is important to exclude chronic alternate diagnoses, including chronic otitis media, before treatment is commenced.
Treatment with corticosteroid/antibiotic combinations should not be continued for more than 7 days in the absence of any clinical improvement, since prolonged use may lead to occult extension of infections due to the masking effect of the steroid.
In children there is a theoretical risk that sufficient steroid may be absorbed to cause adrenal suppression, with prolonged use increasing this risk of adrenal suppression in children.
Prolonged use may also lead to skin sensitisation and the emergence of resistant organisms.
Due to potentially immature renal function in children toxicity may develop, thus caution is warranted when administering neomycin in this age group.
Aminoglycoside antibiotics may cause irreversible, partial or total deafness when given systemically or when applied topically to open wounds or damaged skin. This effect is dose related and is enhanced by renal or hepatic impairment. This possibility should be considered when high doses or prolonged treatment is given to small children.
Therapeutic Class
Ear Anti-Infectives & Antiseptics
Storage Conditions
Do not store above 25ºC. Do not freeze. Keep container upright in the outer carton. Use within one month of first use.
