Usage
- Acetic acid + Hydrocortisone otic solution is prescribed for the treatment of superficial infections of the external auditory canal (outer ear infections, such as swimmer’s ear), caused by susceptible bacteria or fungi, and complicated by inflammation.
- Pharmacological classification: Anti-infective (acetic acid) and anti-inflammatory corticosteroid (hydrocortisone).
- Mechanism of action: Acetic acid creates an acidic environment in the ear canal, inhibiting the growth of bacteria and fungi. Hydrocortisone reduces inflammation, itching, and redness associated with the infection.
Alternate Names
- Acetic acid w/hydrocortisone - otic
- Hydrocortisone-acetic acid otic solution
- Brand names: Acetasol HC, Vosol HC, Orlex HC
How It Works
- Pharmacodynamics: Acetic acid exerts a direct antimicrobial effect, while hydrocortisone suppresses inflammation and its related symptoms.
- Pharmacokinetics: Absorption of both medications is minimal following topical otic administration, primarily local action in the ear canal. Systemic absorption is negligible with an intact tympanic membrane.
- Mode of action: Acetic acid disrupts bacterial and fungal cell membranes. Hydrocortisone binds to glucocorticoid receptors, impacting gene expression and reducing inflammatory mediators.
- Receptor binding/enzyme inhibition/neurotransmitter modulation: Hydrocortisone’s action is mediated by intracellular glucocorticoid receptors, leading to reduced inflammatory cytokine production.
- Elimination pathways: Primarily elimination via evaporation from the ear canal. Small amounts absorbed systemically are metabolized and excreted as other corticosteroids.
Dosage
Standard Dosage
Children: Children over 3 years: same dosage as adults (3 to 5 drops initially every 4-6 hours, then 3-4 times daily). Children under 3 years: use and dosage must be determined by a doctor. Pediatric safety considerations: safety and efficacy not established in children below 3 years of age.
Special Cases:
- Elderly Patients: No specific dosage adjustments are needed.
- Patients with Renal Impairment: No specific dosage adjustments are needed.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are needed due to limited systemic absorption.
- Patients with Comorbid Conditions: Use with caution and close monitoring if comorbid conditions are present that might impact the ear or the immune system.
Clinical Use Cases
- Dosages for specific clinical use cases are not different from standard dosing. The standard dosage applies across all clinical settings.
Dosage Adjustments
- No specific dosage adjustments are needed due to limited systemic absorption and local action in the ear canal.
Side Effects
Common Side Effects
- Stinging or burning sensation in the ear
Rare but Serious Side Effects
- Local irritation or allergic reactions (rare)
Long-Term Effects
- With prolonged use, rare possibility of superinfection (a secondary infection caused by organisms not susceptible to the drug).
Adverse Drug Reactions (ADR)
- Allergic reactions (rash, itching, hives, facial swelling). Contact dermatitis can also occur.
Contraindications
- Perforated tympanic membrane (ruptured eardrum)
- Hypersensitivity to hydrocortisone, acetic acid, or any of the ingredients
- Viral infections of the ear canal (herpes simplex, vaccinia, varicella/chickenpox)
Drug Interactions
- No clinically significant drug interactions have been reported when used topically in the ear canal at recommended dosages.
Pregnancy and Breastfeeding
- Pregnancy: Safety not established. Use only if clearly needed and after careful assessment of benefits and risks. Minimal systemic absorption is expected with proper usage.
- Breastfeeding: Unknown if excreted in breast milk. Use with caution and consult a doctor for benefit/risk assessment. Minimal systemic absorption is expected with proper usage.
Drug Profile Summary
- Mechanism of Action: Acetic acid: antimicrobial; Hydrocortisone: anti-inflammatory.
- Side Effects: Stinging or burning sensation, local irritation (rare), allergic reactions (rare).
- Contraindications: Perforated tympanic membrane, hypersensitivity, certain viral infections.
- Drug Interactions: No clinically significant interactions reported.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh potential risks.
- Dosage: See dosage section.
- Monitoring Parameters: Monitor for resolution of infection, signs of local irritation/allergy, or signs of systemic absorption if the eardrum is perforated.
Popular Combinations
- Acetic acid and hydrocortisone are typically used in combination and not combined with other drugs applied directly in the ear.
Precautions
- General Precautions: Avoid use with perforated eardrum. Discontinue if sensitization or irritation occurs. Ensure ear canal is clean and dry before application.
- Specific Populations: See Dosage/Pregnancy and Breastfeeding sections.
- Lifestyle Considerations: No specific lifestyle considerations related to this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Acetic acid + Hydrocortisone?
A: See Dosage section above for details.
Q2: Can I use this medication if I have a ruptured eardrum?
A: No, a perforated tympanic membrane is a contraindication to the use of this medication.
Q3: What should I do if I experience burning or stinging after application?
A: Mild, transient stinging or burning is common, especially in an acutely inflamed ear. However, persistent or severe irritation should be reported to a doctor.
Q4: Can I swim while using this medication?
A: Avoid swimming unless instructed otherwise by your doctor.
Q5: Can this medication be used during pregnancy?
A: Use only if clearly needed and under the guidance of a doctor. Potential risks to the fetus are not well established.
Q6: Is it safe to use this if I am breastfeeding?
A: Consult with your doctor. It’s not known if this drug passes into breast milk.
Q7: What should I do if my ear infection doesn’t improve after a week?
A: Consult your doctor. It may be necessary to perform cultures and adjust treatment.
Q8: How should I store this medication?
A: Store at room temperature away from light and moisture. Keep out of reach of children.
Q9: Can I use other ear drops along with Acetic acid + Hydrocortisone?
A: No, do not use other ear drops concurrently unless specifically prescribed by your doctor.
Q10: Are there any known drug interactions I should be aware of?
A: No clinically significant drug interactions are known with topical otic use.
