Topical Quinolone Research Articles

Ozenoxacin suppresses sebum production by inhibiting mTORC1 activation in differentiated hamster sebocytes.

Acne vulgaris is a complex condition involving factors that affect the pilosebaceous unit. A primary manifestation of acne pathology is the development of comedones, often linked to the overproduction of sebum resulting from 5α-dihydrotestosterone (5α-DHT) and insulin activity. Ozenoxacin is a topical quinolone that exhibits potent antibacterial activity against Cutibacterium acnes (C. acnes). It is commonly used to treat acne associated with this bacterium; however, its effect on sebum production within the sebaceous glands remains unclear. In this study, the effects of ozenoxacin on sebum production were examined using insulin- and 5α-DHT-differentiated hamster sebocytes. Ozenoxacin showed a dose-dependent inhibition of lipid droplet formation and triacylglycerol (TG) production, which is a major component of sebum. In addition, it suppressed the expression of diacylglycerol acyltransferase 1, stearoyl-CoA desaturase-1, and perilipin-1 mRNA, all important factors involved in sebum synthesis, in a dose-dependent manner. Moreover, ozenoxacin decreased phosphorylated 40S ribosomal protein S6 levels downstream of the mechanistic/mammalian target of rapamycin complex 1 (mTORC1), without altering the phosphorylation of Akt, an upstream regulator of mTORC1, in both insulin- and 5α-DHT-treated hamster sebocytes. Interestingly, nadifloxacin, but not clindamycin, exhibited a similar suppression of sebum production, albeit with lesser potency compared with ozenoxacin. Furthermore, a topical application of a 2% ozenoxacin-containing lotion to the auricle skin of hamsters did not affect the size of the sebaceous glands or epidermal thickness. Notably, it decreased the amount of TG on the skin surface. The results provide novel insights into the sebum-inhibitory properties of ozenoxacin, indicating its potential efficacy in controlling microbial growth and regulating sebum production for acne management.

Ozenoxacin: A Review of Clinical Efficacy on Impetigo Treatment

Impetigo, a common bacterial skin infection primarily affecting children, presents a global prevalence of 11.2%, with higher rates among children aged 2-5 years. Caused mainly by Staphylococcus aureus and Streptococcus pyogenes, impetigo lesions typically appear on the face, neck, and hands, spreading easily through scratching and close contact. Effective disease control is essential to alleviate symptoms, prevent complications such as rheumatic heart disease, and reduce transmission rates. Treatment with antimicrobial agents, especially topical antibiotics, is recommended for localized impetigo. Oral antibiotics are reserved for extensive or systemic infections and outbreaks. However, the emergence of antibiotic-resistant strains, including methicillin-resistant S. aureus (MRSA), poses a significant challenge. There is a pressing need for alternative antimicrobial agents effective against resistant strains. Ozenoxacin, a new topical quinolone, inhibits DNA gyrase and topoisomerase IV, essential enzymes for bacterial DNA replication. Unlike other quinolones, ozenoxacin effectively inhibits both enzymes at low concentrations, penetrating bacterial cells rapidly and achieving high intrabacterial concentrations. In tests against S. aureus and S. pyogenes, ozenoxacin exhibited superior bactericidal activity compared to mupirocin and fusidic acid, achieving a 3-log reduction in colony-forming units within 4 hours. Clinical studies have demonstrated the efficacy and safety of ozenoxacin 1% cream in treating impetigo, with placebo-controlled trials confirming its therapeutic effectiveness. Ozenoxacin holds promise as a valuable addition to the armamentarium against impetigo, particularly in the face of rising antibiotic resistance.impetigo, therapy, ozenoxacin

MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications.
 Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed.
 Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate.
 Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.

Ozenoxacin: A novel topical quinolone

The burden of dermatological conditions is huge on the global health accounting for 44.1 million DALYs worldwide. Impetigo is a highly contagious bacterial infection with 2.5 time’s greater likelihood in pediatrics (12.3%) than in adults (4.9%). Micro-organisms causing impetigo include bacteria like or both. The management of Impetigo is with topical and systemic antimicrobial agents. Topical antimicrobial resistance is on the rise in patients with Impetigo. Therefore, there is clearly a need for newer antimicrobials having different mode of action and showing good activity against non-responding strains in the management of impetigo. Ozenoxacin is a novel, topical quinolone with a good safety and tolerability profile in the management of Impetigo. The authorizing bodies namely USFDA, European Medical Agency, and DCGI have approved the use of Ozenoxacin 1% cream for the topical treatment of impetigo due to in adult and pediatric patients 2 months of age and older.

New therapeutic applications of ozenoxacin in superficial skin infections.

In recent years, the incidence of community- acquired methicillin-resistant S. aureus skin infections (CA-MARSA) has increased in pediatric population without associated risk factors. Ozenoxacin 10mg/g is a topical quinolone that has shown high activity on strains of S. aureus, S. pyogenes and other Gram-positive bacteria sensitive and resistant to methicillin, other quinolones, mupirocin and fusidic acid. Ozenoxacin 10mg/g cream was applied twice a day for 5 days in pediatric patients with superficial skin infections other than non-bullous impetigo where oral antibiotics were not needed. Therapeutic success was achieved in 93.7% of the patients after 5 days of treatment, with a 98.2% decrease in the mean SIRS scale of symptoms. No adverse reaction was reported during treatment. Given the achieved effectiveness, safety, and adherence of the treatment, we believe that pediatricians should consider this topical antibiotic for the treatment of other superficial skin infections, without limiting its use to non-bullous impetigo.

For people with chronic suppurative otitis media, how does a topical quinolone compare with a systemic antibiotic?

For people with chronic suppurative otitis media, how does a topical quinolone compare with a systemic antibiotic?

Topical versus systemic antibiotics for chronic suppurative otitis media.

Topical versus systemic antibiotics for chronic suppurative otitis media.

Topical antibiotics with steroids for chronic suppurative otitis media.

Topical antibiotics with steroids for chronic suppurative otitis media.

Anti-inflammatory effects of ozenoxacin, a topical quinolone antimicrobial agent

Ozenoxacin is a topical quinolone showing potent antimicrobial activities against Gram-negative and Gram-positive bacteria and is widely used for the treatment of inflammatory acne. However, the anti-inflammatory activities of ozenoxacin have not been examined so far. In the present study, we investigated the in vitro and in vivo anti-inflammatory effects of ozenoxacin. The production of interleukin (IL)-6 and IL-8 by human epidermal keratinocytes stimulated by heat-killed Cutibacterium acnes was significantly inhibited by ozenoxacin at concentrations from 1 to 30 μg ml−1. Likewise, the production of IL-6, IL-8, and tumor necrosis factor alpha by stimulated THP-1 cells, a human monocyte cell line, was inhibited by ozenoxacin at concentrations from 1 to 30 μg ml−1. The production of IL-1β by THP-1 was also inhibited by ozenoxacin at the concentration of 30 μg ml−1. Phosphorylation of the mitogen-activated protein kinases and degradation of IκB-α, an inhibitory factor of NF-κB in keratinocytes and THP-1 cells, was increased by stimulation with heat-killed C. acnes. Of these activated intracellular pathways, the p38 phosphorylation pathway was remarkably reduced by ozenoxacin in both keratinocytes and THP-1 cells. In addition, the application of 2% ozenoxacin suppressed the increase in the ear thickness of rats induced by an intracutaneous injection of heat-killed C. acnes. These findings suggest that ozenoxacin possesses an anti-inflammatory activity, which may contribute to its therapeutic effects on inflammatory acne.

Ozenoxacin: A Novel Topical Quinolone for Impetigo.

To review the data supporting Food and Drug Administration (FDA) labeling of ozenoxacin and evaluate its place in therapy for impetigo. A literature search was conducted using PubMed (1966 to May 2018) and Google Scholar (2000 to May 2018) with the search terms ozenoxacin, T-3912, and GF-001001-00. Other resources included clinicaltrials.gov , the manufacturing product label, and the FDA website. All relevant English-language data from abstracts, phase 1 to 4 studies, and review articles were included. FDA labeling of ozenoxacin was based on 2 phase 3 studies conducted in patients 2 months of age and older. Ozenoxacin demonstrated efficacy and safety for use in bullous or nonbullous impetigo from Staphylococcus aureus or Streptococcus pyogenes as compared with placebo. The lack of systemic absorption results in minimal adverse drug reactions. Studies did not detect possible adverse events commonly associated with other quinolone antibiotics. Relevance to Patient Care and Clinical Practice: This topical quinolone has bactericidal activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus. Ozenoxacin may have an expanded clinical role for the treatment of localized impetigo if resistance to current therapies increases significantly. However, ozenoxacin is unlikely to play a significant role in the treatment of impetigo in the foreseeable future, because of lack of direct comparative clinical efficacy data with currently recommended therapies and likely high cost. Ozenoxacin, the first nonfluorinated quinolone, is a safe, topical treatment for impetigo in patients 2 months of age and older. Although clinical trials demonstrate efficacy compared with placebo, comparative trials to current treatment options are needed to identify its therapeutic use.

Topical versus systemic antibiotics for chronic suppurative otitis media

Topical versus systemic antibiotics for chronic suppurative otitis media

Aerobic bacteria associated with chronic suppurative otitis media in Angola

BackgroundChronic suppurative otitis media (CSOM) is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions. Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas. The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations.MethodsSamples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane. Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions. Antimicrobial susceptibility testing was done according to EUCAST.ResultsOne hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates, respectively. In all patients, correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3% and 9.3% comparing isolates from the nasopharynx and ear discharge, respectively. Proteus spp. (14.7%), Pseudomonas aeruginosa (13.2%) and Enterococcus spp. (8.8%) were dominating pathogens isolated from ear discharge. A large part of the remaining species belonged to Enterobacteriaceae (23.5%). Pneumococci and Staphylococcus aureus were detected in approximately 10% of nasopharyngeal samples. Resistance rates to quinolones exceeded 10% among Enterobacteriaceae and was 30.8% in S. aureus, whereas 6.3% of P. aeruginosa were resistant.ConclusionsThe infection of the middle ear in CSOM is highly polymicrobial, and isolates found in nasopharynx do not correspond well with those found in ear discharge. Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceae and P. aeruginosa, while gram-positive enterococci also are common. Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola. Topical antiseptics such as aluminium acetate, acetic acid or boric acid, however, may be more feasible options due to a possibly emerging antimicrobial resistance.

Bactericidal activity and post-antibiotic effect of ozenoxacin against Propionibacterium acnes.

Ozenoxacin, a novel non-fluorinated topical quinolone, is used for the treatment of acne vulgaris in Japan. We investigated bactericidal activity and post-antibiotic effect (PAE) of ozenoxacin against Propionibacterium acnes, a major causative bacterium of acne vulgaris. The minimum inhibitory concentrations (MICs) of ozenoxacin against 3 levofloxacin-susceptible strains (MIC of levofloxacin; ≤4μg/mL) and 3 levofloxacin-resistant strains (MIC of levofloxacin; ≥8μg/mL) ranged from 0.03 to 0.06μg/mL and from 0.25 to 0.5μg/mL, respectively. These MICs of ozenoxacin were almost the same or lower than nadifloxacin and clindamycin. The minimum bactericidal concentrations (MBCs) of ozenoxacin against the levofloxacin-susceptible and -resistant strains were from 0.06 to 8μg/mL and from 0.5 to 4μg/mL, respectively. These MBCs were lower than those of nadifloxacin and clindamycin. In time-kill assay, ozenoxacin at 1/4, 1 and 4 times the respective MIC against both levofloxacin-susceptible and -resistant strains showed a concentration-dependent bactericidal activity. Ozenoxacin at 4 times the MICs against the levofloxacin-susceptible strains showed more potent and more rapid onset of bactericidal activity compared to nadifloxacin and clindamycin at 4 times the respective MICs. The PAEs of ozenoxacin at 4 times the MICs against the levofloxacin-susceptible strains were from 3.3 to 17.1h, which were almost the same or longer than nadifloxacin and clindamycin. In contrast, the PAEs were hardly induced by any antimicrobial agents against the levofloxacin-resistant strains. The present findings suggest that ozenoxacin has a potent bactericidal activity against both levofloxacin-susceptible and -resistant P.acnes, and a long-lasting PAE against levofloxacin-susceptible P.acnes.

Lacrimal sac infections and microbial analysis

Lacrimal sac infection is one of the common pathologies in a routine ophthalmic practice. Dacryocystitis often present as epiphora with or without discharge. Regurgitation of mucopurulent discharge from punctum is a specific indicator of sac infection. In this article, we have reviewed the literature on the microbial spectrum in lacrimal duct obstruction with sac infection. The common microbial organism and the antibiotic sensitivity status of the same have also been reviewed. More than 90% culture positivity is noted in all the studies as noted in the literature. Gram-positive organism is the commonest source of infection. Staphylococcal species, namely, Staphylococcus aureus have been noted to be the most common among the Gram-positive organisms. The other Gram-positive organisms include Streptococcus pneumonia and Staphylococcus epidermidis. The Gram-negative organisms predominantly seen are Pseudomonas aeruginosa, Hemophilus influenza, and Klebsiella. Very rarely anaerobic organism such as Propionibacterium, fungi like Candida, other Gram-negative microbes such as Enterobacter, and occasionally, Mycobacterium are also cultured. Gram-positive organisms are sensitive to Vancomycin, Ofloxacin, Gatifloxacin, and Chloramphenicol. Gram-negative organisms showed sensitivity to Tobramycin. Resistant to topical quinolones has also been reported in some studies. The overall antibiotic sensitivity has been good and encouraging in the management of lacrimal sac infections.

Antimicrobial activities of ozenoxacin against isolates of propionibacteria and staphylococci from Japanese patients with acne vulgaris.

Ozenoxacin, a novel non-fluorinated topical quinolone, was assessed for in vitro antimicrobial activity against clinical isolates of propionibacteria and staphylococci according to the broth microdilution method recommended by the Clinical and Laboratory Standards Institute. The isolates used in this study were collected from Japanese patients with acne vulgaris during a period from 2012 to 2013. The MIC90s of ozenoxacin against Propionibacterium acnes (n=266), Propionibacterium granulosum (n=10), Staphylococcus aureus (n=23), Staphylococcus epidermidis (n=229) and other coagulase-negative staphylococci (n=82) were ≤0.06, ≤0.06, ≤0.06, 0.125 and ≤0.06 µg ml-1, respectively. The antimicrobial activity of ozenoxacin against the clinical isolates of propionibacteria and staphylococci was greater than that of five reference antimicrobial agents which have been used for the treatment of acne vulgaris. The MICs of ozenoxacin were correlated with those of nadifloxacin in P. acnes and S. epidermidis isolates. However, the MICs of ozenoxacin were 0.25-0.5 µg ml-1 and 0.5-8 µg ml-1 against nadifloxacin-resistant P. acnes (MIC: ≥8 µg ml-1; n=8) and S. epidermidis (MIC: ≥64 µg ml-1; n=10), respectively. These results indicated the potent antimicrobial activity against P. acnes and S. epidermidis isolates resistant to nadifloxacin. Topical ozenoxacin could represent an alternative therapeutic drug for acne vulgaris based on its potent antimicrobial activity against the isolates of propionibacteria and staphylococci from acne patients.

Invitro antimicrobial activity of ozenoxacin against methicillin-susceptible Staphylococcus aureus, methicillin-resistant S.aureus and Streptococcus pyogenes isolated from clinical cutaneous specimens in Japan.

Ozenoxacin, a novel non-fluorinated topical quinolone, was assessed for invitro antimicrobial activity against each 50 isolates of methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S.aureus (MRSA), and Streptococcus pyogenes according to the broth microdilution method recommended by the Clinical and Laboratory Standards Institute. The isolates used in this study were recovered from cutaneous specimens of Japanese adult and pediatric patients who visited hospitals in 2014. The MIC90s of ozenoxacin against MSSA, MRSA and S.pyogenes isolates from adult patients were ≤0.06, 4 and ≤0.06μg/mL, respectively. The MIC90s of ozenoxacin against MSSA and S.pyogenes isolates from pediatric patients were equal to those against the adult isolates. On the other hand, the MIC90s of ozenoxacin against the pediatric MRSA isolates was 0.12μg/mL, and was 32 times lower than that against the adult isolates. The antimicrobial activity of ozenoxacin against MSSA, MRSA and S.pyogenes was equal to or greater than those of 7 reference antimicrobial agents had been used for the treatment of skin infections. The MICs of ozenoxacin was highly correlated with those of nadifloxacin and levofloxacin in the 50MRSA isolates (r(2)=0.906 and 0.833, respectively). However, ozenoxacin kept the potent antimicrobial activity with the MIC ranging from 1 to 4μg/mL even against MRSA low susceptible (MIC: >64μg/mL) to nadifloxacin or levofloxacin. Ozenoxacin could represent the first-in-class non-fluorinated quinolone for the topical treatment of various superficial skin infections caused by MSSA, MRSA and S.pyogenes.

Alternaria keratitis after uneventful phacoemulsification in an otherwise healthy adult.

BackgroundFungal infections of self-sealing corneal incisions in cataract surgery are scarce. We report a case of Alternaria keratitis, several weeks after uneventful clear-cornea phacoemulsification.FindingsA 42-year-old woman, with a history of retinitis pigmentosa, complained of painful red right eye, 45 days after uneventful self-sealing clear-cornea phacoemulsification. Slit-lamp examination revealed multiple snow-like contiguous stromal infiltrates, with irregular margins, and no epithelial defect. These infiltrates were unresponsive to topical quinolones and topical corticosteroids as well as oral valaciclovir. Culture from corneal biopsy specimen grew Alternaria species. Management consisted of topical amphotericin-B, and then a combination of topical and oral voriconazole. The corneal infiltrates progressively healed. One year later, the best-corrected visual acuity was 20/400.ConclusionsFungal infection, particularly Alternaria keratitis, should be considered in the differential diagnosis of delayed post-cataract surgery keratitis. Prompt diagnosis and management are mandatory to improve visual prognosis.

Why are ototopical aminoglycosides still first-line therapy for chronic suppurative otitis media? A systematic review and discussion of aminoglycosides versus quinolones.

This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media. The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media. Nine trials met the criteria. Two studies showed a higher clinical cure rate in the quinolone group (93 per cent vs 71 per cent, p = 0.04, and 76 per cent vs 52 per cent, p = 0.009). Four studies showed no statistically significant difference in clinical outcome. A significant difference in microbiological clearance in favour of quinolones was shown in two studies (88 per cent vs 30 per cent, p < 0.001, and 88 per cent vs 30 per cent, p < 0.001). Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

Ozenoxacin: a review of absorption, dermal exposure and toxicity, tolerability and safety studies.

Future MicrobiologyVol. 9, No. 8s ForewordFree AccessOzenoxacin: a review of absorption, dermal exposure and toxicity, tolerability and safety studiesSavion GropperSavion GropperSearch for more papers by this authorPublished Online:11 Sep 2014https://doi.org/10.2217/fmb.14.80AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail Topical antibacterials are useful agents for the management of soft-tissue infections such as impetigo, particularly when compared with systemic therapy, as they avoid unnecessary exposure to the gut flora, which may exert selection for resistance. Topical antibacterials are also easy to use and, as shown in a recent Cochrane systematic review, are at least as effective as systemic agents [1–3]. Furthermore, it is expected that the high dermal drug concentrations associated with local application and the negligible systemic absorption observed in most cases should overwhelm many mutational resistances and therefore be less likely than systemic therapy to cause adverse effects [4]. However, escalating numbers of Gram-positive pathogens, especially Staphylococcus aureus, are becoming increasingly resistant to the leading topical antimicrobials used in clinical practice. For instance, resistance rates to mupirocin (a topical antimicrobial agent) have been reported for S. aureus, ranging from 1.3% in Latin America to 8.7% in Europe. Mupirocin resistance increases in coagulase-negative staphylococci, with reported rates ranging from 12.7% in Europe to 38.8% in the USA [5]. Moreover, several strains of S. aureus are also resistant to methicillin, and methicillin-resistant S. aureus infections are becoming a major concern worldwide. The increasing incidence of community-acquired methicillin-resistant S. aureus infections and resistance to other topical antibacterials justifies the need for alternative therapies for the treatment of skin and soft-tissue infections.Ozenoxacin is a novel, nonfluorinated quinolone formulated for topical use. Preclinical tests have shown that ozenoxacin possesses potent bacteriostatic and bactericidal activity against Gram-positive pathogens such as S. aureus and Streptococcus pyogenes, organisms that are frequently associated with skin and soft-tissue infections [6–8]. These studies indicated that a simplified once- or twice-daily treatment schedule was feasible and should be advantageous in terms of improving compliance and minimizing the risk of treatment failure and the development of resistant strains.In the studies presented in this supplement, the aim has been to address a number of important questions regarding the pharmacokinetic profile (absorption and dermal exposure), dermal tolerability and safety (irritation, sensitization, phototoxicity and photoallergy) and overall tolerability and safety (adverse events) of ozenoxacin, which is currently in development for the topical treatment of various uncomplicated skin and skin structure infections.Financial & competing interests disclosureS Gropper is a full-time employee of Ferrer Internacional SA. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Writing assistance was provided by Content Ed Net, with funding provided by Ferrer Internacional SA.References1 Koning S, van der Sande R, Verhagen AP et al. Interventions for impetigo. Cochrane Database Syst. Rev. 1, CD003261 (2012).Medline, Google Scholar2 Free A, Roth E, Dalessandro M et al. Retapamulin ointment twice daily for 5 days vs oral cephalexin twice daily for 10 days for empiric treatment of secondarily infected traumatic lesions of the skin. Skin Med. 5, 224–232 (2006).Crossref, Medline, Google Scholar3 George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br. J. Gen. Pract. 53, 480–487 (2003).Medline, Google Scholar4 Leyden JJ. The role of topical antibiotics in dermatologic practice (2003). www.medscape.com/viewprogram/2501 Google Scholar5 Deshpande LM, Fix AM, Pfaller MA, Jones RN. SENTRY Antimicrobial Surveillance Program Participants Group. Emerging elevated mupirocin resistance rates among staphylococcal isolates in the SENTRY Antimicrobial Surveillance Program (2000): correlations of results from disk diffusion, Etest and reference dilution methods. Diagn. Microbiol. Infect. Dis. 42, 283–290 (2002).Crossref, Medline, CAS, Google Scholar6 Yamakawa T, Mitsuyama J, Yamashiro Y. In vitro and in vivo antibacterial activity of T-3912, a novel non-fluorinated topical quinolone. J. Antimicrob. Chemother. 49, 455–465 (2002).Crossref, Medline, CAS, Google Scholar7 López Y, Tato M, Espinal P et al. In vitro activity of ozenoxacin against quinolone-susceptible and quinolone-resistant Gram-positive bacteria. Antimicrob. Agents Chemother. 57, 6389–6392 (2013).Crossref, Medline, CAS, Google Scholar8 Tato M, López Y, Morosini MI et al. Characterization of variables that may influence ozenoxacin in susceptibility testing, including MIC and MBC values. Diagn. Microbiol. Infect. Dis. 78, 263–267 (2014).Crossref, Medline, CAS, Google ScholarFiguresReferencesRelatedDetails Vol. 9, No. 8s Follow us on social media for the latest updates Metrics History Published online 11 September 2014 Published in print August 2014 Information© Future Medicine LtdFinancial & competing interests disclosureS Gropper is a full-time employee of Ferrer Internacional SA. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Writing assistance was provided by Content Ed Net, with funding provided by Ferrer Internacional SA.PDF download

A randomised controlled trial of active chronic otitis media comparing courses of eardrops versus one‐off topical treatments suitable for primary, secondary and tertiary healthcare settings

Primary: to compare one-off administration of boric acid powder with courses of 1% acetic acid and ciprofloxacin eardrops in treating active chronic otitis media. Secondary: to evaluate the effectiveness of Quadriderm® cream in resistant active chronic otitis media; and to document side effects of these treatments, especially hearing loss. Randomised controlled trial. Outpatient department of a tertiary ENT unit. Hundred and fifty-nine patients over 6 years old with active chronic mucosal (without cholesteatoma) otitis media randomised to receive one of the three primary agents. All techniques employed were suitable for primary healthcare givers as well as specialists. After confirming eligibility, patients were randomly allocated to treatment. All ears underwent toilet with irrigation using clean water, a syringe and ambient light, with or without dry mopping, until the perforation was visible. The randomised solution was flushed through the middle ear and eustachian tube using a 'tragal pump' technique: saline was used as the solution for flushing in the boric acid powder arm. Patients allocated topical ear medication were given a bottle of eardrops to administer (six drops twice daily, 'pumped in') until finished. Those allocated boric acid powder had the external ear canals filled as a one-off treatment. Patients were followed up monthly thereafter. Primary: Dry (inactive) middle ears as assessed by the doctor. Secondary: Patient assessment of success; microbiologic culture and sensitivity; audiologic changes because of treatment; complications of treatment; costs of therapies. Ciprofloxacin eardrops and boric acid powder were statistically superior to 1% acetic acid eardrops in rendering active chronic otitis media inactive (73% dry ears for ciprofloxacin; 67% for boric acid powder; and 24% for acetic acid). There was no difference between the success rates of ciprofloxacin eardrops and boric acid powder. Quadriderm cream was effective in 85% of patients failing first-line therapy. No agent caused significant complications and specifically no hearing loss. This study showed a single application of boric acid powder following external auditory canal irrigation until the perforation was visible to be as effective as the current best practice of topical quinolone eardrops in active chronic otitis media. Boric acid powder is inexpensive and does not require patient compliance. Boric acid powder is a viable, less costly alternative to topical antibiotic/steroid ear drops in the developing world for active chronic otitis media. Acetic acid eardrops 1% are ineffective. Quadriderm cream, given as a one-off therapy, also appears to be effective.