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Tierarztl Prax Ausg K Kleintiere Heimtiere 2012; 40(03): 161-170
DOI: 10.1055/s-0038-1623642
Originalartikel
Schattauer GmbH

In-vivo-Wirksamkeit eines kommerziellen Chlorhexidin und Tris-EDTA enthaltenden Ohrreinigers

Eine randomisierte, plazebokontrollierte DoppelblindstudieIn-vivo efficacy of a commercial ear antiseptic containing chlorhexidine and Tris-EDTAA randomised, placebo-controlled, double-blinded comparative trial
C. Bouassiba
1   Tierärztliche Praxis Dr. Wolfgang Osthold, Schwalmtal
,
W. Osthold
1   Tierärztliche Praxis Dr. Wolfgang Osthold, Schwalmtal
,
R. S. Mueller
2   Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

Eingegangen: 25 July 2011

Akzeptiert nach Revision: 04 January 2012

Publication Date:
06 January 2018 (online)

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Zusammenfassung

Gegenstand und Ziel: Ein wichtiger Aspekt einer erfolgreichen Therapie der Otitis externa (OE) ist die Reinigung des Gehörgangs. Dafür stehen verschiedene Präparate zur Verfügung. Im Hinblick auf steigende Antibiotikaresistenzen wird eine Keimbekämpfung in Kombination mit Antiseptika angestrebt. Die plazebokontrollierte Doppelblindstudie überprüfte die In-vivo-Wirksamkeit eines Chlorhexidin (1500 μg/ml) und Tris-EDTA (48 μg/ml) enthaltenden kommerziellen Ohrreinigers anhand klinischer Symptomatik, zytologischer und bakteriologischer Untersuchung. Material und Methoden: An 64 Hunden mit OE wurde dieser Ohrreiniger (Gruppe A) bzw. das Plazebo (Gruppe B) zweimal täglich angewendet, einmal täglich gefolgt von der Applikation eines Marbofloxacin/Dexamethason/Clotrimazol enthaltenden Ohrmedikaments. Die Kontrolluntersuchung fand nach 14 Tagen statt. Die Auswertung erfolgte klinisch und zytologisch. Ferner wurde zu Beginn sowie nach 14 Tagen aus jedem Ohr eine Tupferprobe entnommen und bakteriologisch untersucht. Ergebnisse: Verglichen mit dem Plazebo kam es bei Anwendung des Ohrreinigers zu einer signifikanten Reduktion der Kokken, Stäbchen und neutrophilen Granulozyten. Die Hefenzahl verringerte sich in beiden Gruppen signifikant. Klinisch bestand kein signifikanter Unterschied zwischen den Gruppen. Die Zahl Marbofloxacinresistenter Bakterien stieg in Gruppe A von 0 auf 44%, in Gruppe B von 8 auf 31%. Schlussfolgerung: Chlorhexidin und Tris-EDTA führten in Kombination mit Marbofloxacin/Dexamethason/Clotrimazol zu einer zytologisch verifizierbaren Keimreduktion. Die Zahl Marbofloxacin-resistenter Bakterien stieg unter dieser Therapie signifikant an. Klinische Relevanz: Die Ergebnisse lassen die Vermutung zu, dass eine Kombination von Chlorhexidin und Tris-EDTA zusammen mit antimikrobiellen Ohrentropfen zur Reduktion der bakteriellen Besiedelung einer bakteriell bedingten OE empfohlen werden kann, doch das Risiko der Resistenzentwicklung besteht. Basierend auf den Resultaten können lokale Nebenwirkungen erwartet werden.

Summary

Aim: The important aspect of a successful therapy for otitis externa is cleaning of the external canal. Several cleaners are available for this purpose. In the light of increasing bacterial resistance against antibiotics a combined therapy with antiseptics is desirable. The aim of this study was to evaluate the efficacy of a cleaner containing chlorhexidine (1500 μg/ml) and Tris-EDTA (48 μg/ml) clinically, cytologically and microbiologically in a placebo-controlled double-blinded trial. Material and methods: In 64 dogs ear cleaner (group A) or placebo (group B) was used twice daily followed by an ear medication containing marbofloxacin/dexamethasone/clotrimazole once daily. After 2 weeks patients were re-evaluated clinically and cytologically. In addition at the beginning and after 14 days an ear swab of each ear underwent a microbiological examination and sensitivity testing. Results: On cytology, there was a significant reduction in the count of cocci (p < 0.0001), rods (p = 0.007) and neutrophils (p = 0.0001) in the treatment compared to the placebo group. Yeasts were significantly reduced in both groups (group A p < 0.0001, group B p < 0.001). Clinical examination did not reveal a significant difference between the two groups (p = 0.59). The number of marbofloxacin-resistant bacteria increased in group A from 0 to 44% (p = 0.0025) and in group B from 8 to 31% (p > 0.05). Conclusion: Chlorhexidine and Tris-EDTA in combination with marbofloxacin/dexamethasone/clotrimazole were effective in cytological reduction of bacteria in canine infectious otitis externa. The number of marbofloxacin-resistant bacteria increased significantly. Clinical relevance: Based on this study, chlorhexidine and Tris-EDTA in combination with antimicrobial ear medication can be assumed to be recommended for the treatment of otitis externa complicated by bacterial infection to reduce bacteria, however the high risk of resistance development exists. Side effects are to be expected.

Schlüsselwörter

Otitis externa - Hund - Antiseptika - Zytologie

Key words

Otitis externa - dog - antiseptics - cytology
 

  • Literatur

  • 1 Angus JC. Otic cytology in health and disease. Vet Clin North Am: Small Anim Pract 2004; 34 (02) 411-424.
    CrossrefPubMedGoogle Scholar
  • 2 Angus JC, Campbell KL. Uses and indications for video-otoscopy in small animal practice. Vet Clin North Am: Small Anim Pract 2001; 31 (04) 809-827.
    CrossrefPubMedGoogle Scholar
  • 3 Aoki-Komori S, Shimada K, Tani K, Katayama M, Saito TR, Kataoka Y. Microbial flora in the ears of healthy experimental beagles. Exp Animal 2007; 56 (01) 67-69.
    PubMedGoogle Scholar
  • 4 August JR. Otitis externa: A disease of multifactorial etiology. Vet Clin North Am: Small Anim Pract 1988; 18 (04) 731-742.
    CrossrefPubMedGoogle Scholar
  • 5 Chickering WR. Cytologic evaltuation of otic exudate. Vet Clin North Am: Small Anim Pract 1988; 18 (04) 773-782.
    CrossrefPubMedGoogle Scholar
  • 6 Cole LK. Anatomy and physiology of the canine ear. Vet Dermatol 2010; 20: 412-421.
    PubMedGoogle Scholar
  • 7 Farca AM, Piromalli G, Maffei GR. Potentiating effect of EDTA-Tris on the activity of antibiotics against resistant bacteria associated with otitis, dermatitis and cystitis. J Small Anim Pract 1997; 38: 243-245.
    CrossrefPubMedGoogle Scholar
  • 8 Ghibaudo G, Cornegliani L, Martino P. Evaluation of the in vivo effects of Tris-EDTA and chlorhexidine digluconate 0.15% solution in chronic bacterial otitis externa: 11 cases. Vet Dermatol 2004; 15 (Suppl. 01) 65 (abstract).
    PubMedGoogle Scholar
  • 9 Goldschmidt MC, Wyss O. The role of Tris in EDTA toxicity and lysozyme lysis. J Gen Microbiol 1967; 47: 421-431.
    CrossrefPubMedGoogle Scholar
  • 10 Gortel K. Otic flushing. Vet Clin North Am: Small Anim Pract 2004; 34 (02) 557-565.
    CrossrefPubMedGoogle Scholar
  • 11 Gray GW, Wilkinson SG. The effect of ethylenediaminetetra-acetic acid on the cell walls of some gram-negative bacteria. J Gen Microbiol 1965; 39: 385-99. (abstract).
    CrossrefPubMedGoogle Scholar
  • 12 Greene CE. Infectious Diseases in the Dog and Cat. 3rd edn. St. Louis, Missouri, USA: Saunders Elsevier; 2006: 274-301.
    Google Scholar
  • 13 Guardabassi L, Schwarz S, Lloyd DH. Pet animals as reservoirs of antimicrobial-resistant bacteria. J Antimicro Chemother 2004; 54: 321-332.
    CrossrefPubMedGoogle Scholar
  • 14 Guardabassi L, Ghibaudo G, Damborg P. In vitro antimicrobial activity of a commercial ear antiseptic containing chlorhexidine and Tris-EDTA. Vet Dermatol 2010; 21 (03) 282-286.
    CrossrefPubMedGoogle Scholar
  • 15 Guardabassi L, Houser GA, Frank LA. et al. Guidelines for antimicrobial use in small animals. In: Guide to Antimicrobial Use in Animals. Guadabassi L, Jensen LB, Hilde K. eds. Oxford: Blackwell; 2008: 183-206.
    Google Scholar
  • 16 Hariharan H, Coles M, Poole D, Lund L, Page R. Update on antimicrobial susceptibilities of bacterial isolates from canine and feline otitis externa. Canadian Vet J 2006; 47 (03) 253-255.
    PubMedGoogle Scholar
  • 17 Harper WES, Epis JA. Effect of chlorhexidine/EDTA/Tris against bacterial isolates from clinical specimens. Microbios 1987; 51: 107-112.
    PubMedGoogle Scholar
  • 18 Harvey RG, Harrari J, Delauche A. Ohrkrankheiten bei Hund und Katze. Stuttgart: Schattauer; 2003
    Google Scholar
  • 19 Heusinger A. Prüfbericht “Keimhemmung durch Präparate der Firma Alfavet”. LABOKLIN; Bad Kissingen, Germany: 2007
    Google Scholar
  • 20 Kowalski JJ. The microbial environment of ear canal in health and disease. Vet Clin North Am: Small Anim Pract 1988; 18 (04) 743-754.
    CrossrefPubMedGoogle Scholar
  • 21 Kuyyakanond T, Quesnel LB. The mechanism of action of chlorhexidine. FEMS Microbiol Letters 1992; 79 1–3 211-215.
    PubMedGoogle Scholar
  • 22 Lambert RJW, Hanlon GW, Denyer SP. The synergistic effect of EDTA/antimicrobial combinations on Pseudomonas aeruginosa. J Appl Microbiol 2004; 96 (02) 244-253.
    CrossrefPubMedGoogle Scholar
  • 23 Lefebvre HP, Schneider M, Dupouy V, Laroute V, Costes G, Delesalle L, Toutain PL. Effect of experimental renal impairment on disposition of marbofloxacin and its metabolites in the dog. J Vet Pharmacol Ther 1998; 21 (06) 453-461.
    CrossrefPubMedGoogle Scholar
  • 24 Linek M. Otitis externa und media bei Hund und Katze. Tierärztl Prax 2011; 39 (K): 451-463.
    PubMedGoogle Scholar
  • 25 McDonnell G, Russell D. Antiseptics and disinfectants: Activity, action, and resistance. Clin Micro Rev 1999; 12: 147-179.
    CrossrefPubMedGoogle Scholar
  • 26 McKeever PJ, Torres AM. Ear disease and its management. Vet Clin North Am: Small Anim Pract 1997; 27 (06) 1523-1536.
    CrossrefPubMedGoogle Scholar
  • 27 Merchant SR, Neer M, Tedford BL, Twedt AC, Cheramie PM, Strain GM. Ototoxicity assessment of a chlorhexidine otic preparation in dogs. Prog Vet Neuro 1993; 04 (03) 72-75.
    PubMedGoogle Scholar
  • 28 Mills PC, Ahlstrom WJ. Ototoxicity and tolerance assessment of a TrisEDTA and polymethylene biguanide ear flush formulation in dogs. J Vet Pharm Ther 2005; 28 (04) 391-397.
    CrossrefPubMedGoogle Scholar
  • 29 Morris DO. Medical therapy of otitis externa and otitis media. Vet Clin North Am: Small Anim Pract 2004; 34: 541-545.
    PubMedGoogle Scholar
  • 30 Nuttall T, Cole LK. Ear cleaning; the UK and US perspective. Vet Dermatol 2004; 15: 127-136.
    CrossrefPubMedGoogle Scholar
  • 31 Oliveira LC, Leite CAL, Brilhante RSN, Carvalho CBM. Comparative study of the microbial profile from bilateral canine otitis externa. Canadian Vet J 2008; 49: 785-788.
    PubMedGoogle Scholar
  • 32 Pankow WR, Bolkart B. Zur Wirksamkeit von AURIZON® bei akuter und chronischer Otitis externa (Hund) unter besonderer Berücksichtigung der antimikrobiellen Aktivität von Marbofloxacin. Vetoquinol Gmbh, Chassot GmbH; 88212 Ravensburg: Manuskript “AURIZON® 2004”.
    Google Scholar
  • 33 Qiu D, Huang Z, Zhou T, Shen C, Hider R. In vitro inhibition of bacterial growth by iron chelators. FEMS Microbiol Letters 2011; 314: 107-111.
    CrossrefPubMedGoogle Scholar
  • 34 Sanchez IR, Swaim SF, Nusbaum KE, Henderson RA, McGuire JA. Effects of chlorhexidine diacetate and povidone-iodine on wound healing in dogs. Vet Surg 1988; 17 (06) 291-295.
    CrossrefPubMedGoogle Scholar
  • 35 Saridomichelakis MN, Farmaki R, Leontides LS, Koutinas AF. Aetiology of canine otitis externa: a retrospective study of 100 cases. Vet Dermatol 2007; 18: 341-347.
    CrossrefPubMedGoogle Scholar
  • 36 Swanton A-K, Cikota R, Guardabassi L. Tris-EDTA und 0,15%iges Chlorhexidin als alleinige Behandlung der Otitis externa beim Hund. icfBulletin Results. 2009 http://www.icfpet.com
    PubMedGoogle Scholar
  • 37 Swinney A, Fazakerley J, McEwan N, Nuttall T. Comparative in vitro antimicrobial efficacy of commercial ear cleaners. Vet Dermatol 2008; 19: 373-379.
    CrossrefPubMedGoogle Scholar
  • 38 Tatnall FM, Leigh IM, Gibson JR. Comparative study of antiseptic toxicity on basal keratinocytes, transformed human keratinocytes and fibroblasts. Skin Pharmacol 1990; 03 (03) 157-163.
    CrossrefPubMedGoogle Scholar
  • 39 Trott DJ, Moss SM, See AM. Evaluation of disc diffusion and MIC testing for determining susceptibility of Pseudomonas aeruginosa isolates to topical enrofloxacin/silver sulfadiazine. Australian Vet J 2007; 85: 464-466.
    CrossrefPubMedGoogle Scholar
  • 40 Vaara M. Agents that increase the permeability of the outer membrane. Microbio Mol Biol Rev 1992; 56 (03) 395-411.
    PubMedGoogle Scholar
  • 41 Wilcke JR. Otopharmacology. Vet Clin North Am: Small Anim Pract 1988; 18 (04) 783-798.
    CrossrefPubMedGoogle Scholar
  • 42 Wooley RE, Jones MS. Action of EDTA-Tris and antimicrobial agent combinations on selected pathogenic bacteria. Vet Microbiol 1983; 08 (03) 271-280.
    CrossrefPubMedGoogle Scholar
  • 43 Wooley RE, Jones MS, Gilbert JP, Shotts EB. In vitro action of combinations of antimicrobial agents and EDTA-tromethamine on Pseudomonas aeruginosa. Am J Vet Res 1983; 44 (08) 1521-1524.
    PubMedGoogle Scholar
  • 44 Wooley RE, Jones MS, Gilbert JP, Shotts EB. In vitro effect of combinations of antimicrobial agents and EDTA-tromethamine on certain gram-positive bacteria. Am J Vet Res 1983; 44 (11) 2167-2169.
    PubMedGoogle Scholar
  • 45 Yoshida N, Naito F, Fukata T. Studies of certain factors affecting the microenvironment and microflora of the external ear of the dog in health and disease. J Vet Med Sci 2002; 64 (12) 1145-1147.
    CrossrefPubMedGoogle Scholar