Otitis Externa, Making the Best Treatment Choice (Advertorial)

Canine otitis externa (OE) is a condition that all general practitioners are familiar with but with the ever-changing therapeutic space, how do we stay up to date and ensure that we are making the best treatment choices for our patients?

When approaching the canine OE case, it’s helpful to follow a problem orientated approach, formulating a plan that addresses secondary infection with short-term treatment, followed by long-term management of the primary and perpetuating causes of ear inflammation. Otitis externa is after all a secondary manifestation of a primary problem.  The patient’s history is a crucial part of the investigation and forms the basis for your long-term plan. Without the right therapeutic management of infection, and good owner communication regarding the primary cause, you will inevitably have a frustrating and recurrent OE case, with equally frustrated clients.

Your short-term treatment plan is based on information gathered during a thorough patient history and examination, this should always include an otoscopic exam and cytology of the external ear canals.  Medicating according to the individual’s cytology results is vital, rather than selecting the medication with the broadest antibiotic cover.

Canine otitis externa cases largely fall into 2 groups, the ceruminous and erythematous ear (yeast and cocci) making up 70-90%¹ of acute cases, and the ulcerative and suppurative ear, mostly due to rods. Cases may be complicated by the presence of an otitis media, where culture and sensitivity testing should be considered, or a ruptured tympanic membrane, in which careful consideration of therapeutic choice is required.

With the yeast and cocci group being the most common, we will be focusing on the best way to choose an appropriate topical ear medication for your canine patient in this group.

Once you have established on cytology that you have a case involving cocci and/or yeast, it’s time to consider your topical therapy options, starting with the anti-inflammatory or glucocorticoid. Your aim should be for rapid relief from pain and pruritis and reduced inflammation to restore the normal skin barrier within the ear.

The next component to consider is the antibiotic. With >95%² of cocci identified on ear cytology Staphylococcus pseudintermedius, it is important to choose an antibiotic with proven efficacy against these cocci. An appropriate and responsible first-line choice is florfenicol of the chloramphenicol class. The fluoroquinolone and aminoglycoside (gentamicin) classes should be avoided as they are better suited to more complicated OE cases involving gram-negative bacteria or rods.

 “These two classes of antibiotics are our best 'weapons to kill' rods, and rods as you may know, are usually the most challenging to treat, so save your weapons. Try your best to avoid using fluoroquinolones and aminoglycosides to kill yeast and cocci." Dr Tatiana Lima, Registered Veterinary Dermatologist, SASH³.

Lastly, the antifungal component should be effective against Malassezia pachydermatis.

Neptra^TM is the only one-dose, vet administered ear formulation containing the most potent⁴ glucocorticoid mometasone, the responsible antibiotic for cocci infections, florfenicol and antifungal, terbinafine to treat your most common canine OE cases. Add to this the advantage of complete control over treatment compliance, Neptra is the obvious first-line choice for treatment of your everyday canine otitis externa cases.  

References:

1. Malayeri, HZ, Identification and antimicrobial susceptibility patterns of bacteria causing otitis externa in dogs. Veterinary Research Communications 2010 435
2. Lynch SA, Helbig KJ. Vet Sci. 2021,8:11
3. https://academy.sashvets.com/courses/otitis-externa
4. https://www.bsavalibrary.com/content/chapter/10.22233/9781910443774.ch93sec3 Neptra-The Future is Long Acting, Dr Sue Paterson.

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