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The best dog Ear medications in Australia and why.

-happy-poodle-head.In Australia when your dog has an inflammation of the ear issue that is caused by either fungal or bacteria or both a vet will often have a visual inspection, take a swab for specific infection analysis, give cortisone injections and support it with Surolan Ear ointment for you to take home and use daily for ten days or so.

We describe below what ear medications are available for your dog on prescription and off, and what the total options for you and your dog are.

The reason that prescriptions are believed to be necessary for these medications is that they are potent AND vet inspection is necessary for them to visually see that there are not other physical ear issues like lesions or ear drum tears.  They might also see the specific form of the bacteria is so that the right medication can be used rather than trying to control with a general 'broad spectrum' anti bacterial.

This FORMULA used by most ear infection creams you syringe into your dogs ear are triple ACTION. Specifically these medications =  Anti-inflammatory + anti-fungal + antibacterial ointment

 

These medications are for treatment of acute and chronic canine otitis externa associated with yeast and/ or bacteria secondary infections in a dogs ear.

The contra-indications are typically listed as :  FOR OTIC USE IN DOGS ONLY. Do not use in animals with known perforation of the eardrum (tympanic membrane). Do not use in pregnant or lactating animals. Do not use concomitantly with drugs known to induce ototoxicity.

The reason I have had to use Surolan and similar medications over the years is connected to his dog skin allergy. We believe that environmental substances have his body go into over-drive creating too many histamines. These chemicals make the skin itchy, he licks and scratches his paws and ears and this action plus the bodies own reaction cause swelling, then allow uncontrolled growth of fungus and bacteria until a dangerous level of secondary infection (often charactised by a strong infected ear smell) becomes obvious.

Surolan has been used by our local vets because it "treats ear infections (otitis externa) and dermatitis in dogs. Surolan are effective against infections caused by yeast, fungi, and gram-positive and gram-negative bacteria. It also soothes itching and treats ear mite infestations."

The infections can be caused by chronic allergies such as to food or environment (grasses) and surolan is only recommended for short periods so that the fungus or bacteria do not build up a resistance to it.  After the inflammation has abated a weekly ear wash (most commercial versions use a combination of light acids to create an environment that bacteria and fungus find bad to grow in).

The problem with dog mid-term ear inflammation

Recently my dog had a severe ear infection, and my vet recommended Surolan, and it took three visits, three prescriptions of highly priced Surolan 30 ml purchases and six weeks to get his inflammation under control.

Older dogs that have a had a history of ear issues can have comprised immune systems that allow these secondary infections to flourish and make it difficult to remove. As a btw, my dog is half poodle, and that breed has a high percentage of dogs with genes predisposed to skin allergies. Daily doses of Omega 3 fish oil have drastically increased skin infections, in conjunction with medicated weekly shampoo and conditioners, but lately allergy flare-ups have meant I have had to make further investigations.

NOTE many of our Kangaroo and Fish meat dog treats have high levels of great Omega 3 which can help prevent many of the skin allergy and ear problems in the first place. Or at least drastically reduce the number that a skin allergy dog will have in its lifetime !

The vet suggested to give my dog a weekly ear flush of Surolan from the remainder of the bottle, however knowing how long the last bout of ear issues took to resolve, and having a new one occur (ear scratching and head shaking) had me research and provide you this information on ALL your options.

Surolan is an ok option if the symptoms are the same as before, if the dog doesn't have violent or continual head shaking like a mite or grass seed might cause.  They recommended that I finish the remaining Surolan when his issues faired up, and that is what I am doing, but I am looking for a mid-term solution, to reduce the reliance on one product or further unnecessary vet visits. One where my dog is comfortable each day of its life, itch and ear problem free.

Sometimes getting the ear environment just right, when unseasonal weather has extended grass flowering seasons for instance, means that perhaps a dog needs another short surolan type boost.

But really an owner should understand as much as possible why a treatment is used with their dog, why it might not work, and what alternatives are available.

The ingredients in prescription dog ear medication

Many people prefer herbal or naturopath type solutions, but having experienced the ineffectiveness of many of these in the past, and the advanced age of my dog, I don't want to mess around. It took a long time for Surolan to work the last time, because the populations of the infections had taken such a strong hold in his ear.  Delayed intervention can add weeks to recovery.

The issue for anyone who has used Surolan knows, is that in Australia and most countries, it is of sufficient power that it is prescription only, meaning you can double the price of the already expensive medication by adding a vet visit for each 30 ml bottle. For some people $100 each couple of weeks on top of their dog treats, dog food, dog insurance, dog walker bill isn't that expensive, but for some its also a matter of not allowing the infections to build resistance.

Surolan active ingredients are:

Miconazole nitrate 23 mg/mL, 
prednisolone acetate 5 mg/mL, 
polymyxin B sulfate 0.529 mg/mL.

Where azole = andtifungals, solone = anit inflammatory class, myxin = anti bacterial classes

AND so this is the SAME formula for all major dog ear medications.

DOG EAR OINTMENT = Anti inflammatory + Anti Fungal, + Anti bacterial

BELOW are the major chemical classes used in each segment of the formula, and as you will see after this section, we show examples of brands of ear ointment that you can buy (under prescription) that show you just how simply firms mix and match various types.  This tweaking might lead to better efficacy for your dogs ear !

1          Corticosteroids  (anti inflammatory ) and dogs

These drugs are applied topically orally or by injection. Topical applications are used for both the skin and the eye.  Its main function is to reduce inflammation that causes pain, and the most common ones are :  prednisolone, prednisone, triamcinolone, and dexamethasone.  

Side effects can be major,  the affect all cells of a dogs body and some corticosteroids can slow down the healing process of wounds. It can cause  stomach ulcers and thyroid hormone suppression.  It will increase their thirst and hunger.

Long term  the use of corticosteroids can cause thinning skin and weakened bones, affect dog 'emotions' etc.  You do not want your dog on Corticosteroids long term. You need to remove the thing causing the allergies or find a way to change the ear environment like the medicated ear flushes etc.

2          azole antifungal  prevents the growth of fungus in dogs ears.

Common antifungal medications include: Clotrimazole, Fluconazole, Ketoconazole, Miconazole, Econazole

Miconazole is the version used in surolan.  The typical uses of azoles for humans are to treat thrush, athlete's foot, or a nail infection, Miconazole obviously kills the most common type of fungus found in dogs ears that cause the inflammation.

The most common types of bad reactions to azoles are:  allergic reactions liver problems.  In most of my dog's ear infection issues the smelly discharge is caused by the fungal component.  Surolan claims that  96.7% of dogs see improvement within just 7 days.  But clearly not for my dog.

Other ear cleaners do use the other azoles.  For instance  MalAcetic ULTRA Otic Cleanser uses  0.15% ketoconazole (antifungal).

Mometamax Otic Suspension is another prescription only solution that contains gentamicin (broad-spectrum antibiotic), mometasone (steroid), and clotrimazole (antifungal)

3          Anti bacterials and dogs ears

Surolan contains polymyxin B sulfate 0.529 mg/mL.

MOMETAMAX uses  Gentamicin as a broad-spectrum antibiotic (equivalent to 3 mg gentamicin base),   Otomax (uses Gentamicin Sulfate),  Otikfree Ear Drops (uses  Polymyxin B Sulphate)

Topical antibiotics for dog and cat ear infections

"The following prescription antibiotics benefit pets with bacterial ear infections (otitis) but are not safe unless the eardrum is intact: gentamycin (Otomax and Mometamax), tobramycin, amikacin, neomycin (Posatex Otic Suspenion) and polymixin B.

Some pets are allergic to antibiotics, especially to topical neomycin; if your pet's ear becomes worse with antibiotic treatment, stop the medication and call your veterinarian."    (1800petmeds)

Prescription dog ear ointments on the market

Having read the above information you can see that the way that most ear medications (on intact ears) use a combination of anti inflammatory, anti fungal and anti bacterial.

It is either the efficacy or the brand penetration of Surolan that makes it such a favourite with Melbourne vets.  But as you can see for each class of drug, substitute products use an alternative basically a chemical tweak on the regular class of the cortisone, anti inflammatory or anti bacterial.

The issue is that many of these alternatives are also prescription only.  If your dog has already been diagnosed and prescription Surolan, and you have a relatively mild case of ear infection that you are just trying to prevent becoming 'full blown' then finding an ear flush that has similar THREE classes of drugs, with sufficient concentrations is an option for you to consider. (Though always consult your vet about this advice)

The truth is that following my vet suggestion, I want to use this medicated ear clean once per week immediately after his full body dog wash, particularly if any water has entered the ear canal.  But if I use Surolan for maintenance, I will need to visit the vets about once every ten weeks for life. That is typing up both of our resources, unnecessarily.

Note ear treatments like Surolan are usually an opaque cream you inject. Ear washes are sometimes used in conjunction with these more powerful ear medications, and they are mostly acid based solutions. A dog Ear wash is supposed to remove ear debris & wax and change the PH, they dont as easily KILL the fungus or bacteria or reduce the inflammation. 

For comparison:  Surolan active ingredients are:  Miconazole nitrate 23 mg/mL, prednisolone acetate 5 mg/mL, polymyxin B sulfate 0.529 mg/mL.

Otikfree Ear Drops   (unitedpharmacies)

"Surolan is sold in pharmacies as "Otikfree Ear Drops". It is also possible to purchase Otikfree Ear Drops in online store. It usually it doesn't require doctor's receipt. Surolan also can be sold as:  Polymyxin B Sulp. " (canadianstronghealth)

Otikfree  Active Ingredients :  Otikfree Ear Drops (Miconazole Nitrate /Prednisolone Acetate / Polymyxin B Sulphate) - 23mg /  5mg/  5500iu/mL (15mL) This appears to be the same as use in Surolan. HOWEVER a quick scan of the internet shows that it is universally SOLD OUT ?

Condtions on use" " Normally prescriptions are for 2 or 3 weeks, or until the infection has been successfully treated. Do not use Otikfree Ear Drops in pregnant animals. Avoid contact with eyes. " country of Origin : India

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OTHER solutions similar to surolan

Aurizon Ear Drops   ***Prescription Required***

Active ingredients: Each ml contains 3mg marbofloxacin, 10mg clotrimazole and 0.9mg dexamethasone acetate.

Canaural Ear Drops  ***Prescription Required***

Active ingredients: Each gram contains 5mg diethanolamine fusidate, 5mg framycetin sulfate, 100,000 IU nystatin and 2.5mg prednisolone.

Dermotic Ear & Skin 40ml  ***Prescription Required***

Miconazole nitrate 23 mg/mL,  Prednisolone acetate 5 mg/mL,   Polymyxin B sulfate 0.696 mg/mL

Easotic Ear Drops  ***Prescription Required***

Active ingredients: Each ml contains 1.11mg hydrocortisone aceponate, 15.1mg miconazole (as the nitrate), 1505IU/ml gentamicin (as the sulphate).

Otomax Ear Ointment  ***Prescription Required***

Active ingredients: Each ml contains 3409 IU gentamicin sulfate (equiv. gentamicin base), betamethasone valerate equiv. to betamethasone 1.14mg and 11.36mg clotrimazole.

PMP (Apex) Ear Suspension (30ml bottle)

 Active ingredients: Each ml contains 0.696mg polymyxin b sulphate, 5mg prednisolone acetate, 23mg miconazole 0.696mg Polymyxin b sulphate, 5mg Prednisolone acetate, 23mg Miconazole nitrate.

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Alternative to the regular classes of ear medication

Zymox Plus Otic 1.0% Hydrocortisone

- Zymox is antibiotic FREE
- Broad spectrum antibacterial and antifungal properties

Active Ingredient: Hydrocortisone (1.0%),  Other Ingredients: Propanediol, Glycerin, Benzyl Alcohol, Dextrose, Hydroxypropyl Cellulose, Purified Water, D-Mannose, Potassium Iodide Natural Enzymes: Lysozyme, Lactoferrin, Lactoperoxidase, Beta-Glucanase, Cellulase, Pectinex, Protease, Glucose Oxidase.

Zymox Plus with Biofilm reducing complex contains 4 active enzymes that have been shown to be antibacterial, antifungal and antiviral. Biofilm is an ill-defined mix of polysaccharides, nucleic acids and proteins encased in a slimy matrix. The four additional enzymes in Zymox PLUS work synergistically to attack this mix to break down the complex structure, prevent adhesion and metabolize the biofilm components. When combined with the patented antimicrobial LP3 Enzyme System, the results are antibacterial and antifungal with effective biofilm destruction.

COMMENT -  As you can see this formula uses a cortisone to reduce inflammation, but not any strong antibacterial or antifungal chemicals to attack the issues head on. They instead aim to kill the bio-film that protects these issues. They contain a LOT more ingredients but not using the more direct path that Surolan is known to use.  One site says that they use zymox because  "Natural remedies for ear infections are a safer alternative to many ear medications because some medications may increase the risk of hearing loss in pets. "

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northwestpharmacy  gives a short list of OTHER dog ear applications "similar" to Surolan.

 ILIUM Ear Drops  (dichlorphen / lignocaine hcl / piperonyl butoxide / pyrethrins)

Dichlorophen is an anticestodal, fungicide, germicide, and antimicrobial agent that works to interfere with cell membranes in order to cause their content to leak out so the fungi, germs, or bacteria cannot reproduce. Piperonyl Butoxide is a synergist, meaning it has no pesticidal activity but is there to enhance the potency of certain pesticides, including Pyrethrins. 

A NOTE ON Maleseb Medicinal shampoo as an ear wash.

We use maleseb medicated dog shampoo weekly to prevent fungal and bacterial infections on our dog's body.  The main issue is that it is so strong that it tends to dry  the skin out and takes ten minutes to work before you can wash it out before applying the medicinal conditioner to condition the skin.  Some people suggest you can use this diluted 1/ 20 in a dogs ear as an ear flush.

My vet has warned me not to use this, they read a report that it can be bad.

The active ingredients in maleseb are: 2% Chlorhexidine Gluconate,  2% Miconazole Nitrate (20 ml/ L).  Meanwhile Surolan has Miconazole nitrate 23 mg/mL, prednisolone acetate 5 mg/mL, polymyxin B sulfate 0.529 mg/mL. 

This means it has the same amount of anti bacterial Miconazole nitrate but uses Chlorhexidine Gluconate as its topical antifungal instead of polymyxin B sulfate that surolan uses.

So the question is if Chlorhexidine Gluconate is safe for a dogs ear.

It turns out that an ear flush called TrizCHLOR 4 Flush - has the Active Ingredient - Chlorhexidine gluconate  0.15%    It Contains Tromethamine (Tris) USP, Edetate Disodium Dihydrate (EDTA) USP, 0.15% Chlorhexidine Gluconate buffered to pH 8 with Tromethamine HCL and deionized water.
The patented tris-EDTA formula is said to enhance the bacteria killing ability of Chlorhexidine - much more effective than using products with only Chlorhexidine - safe to use in ears for superior bacteria, fungus and yeast killing power

OTOCOMB OTIC ear drops and ointment  (HUMAN EAR medicine)

triamcinolone acetonide (corticosteroids), neomycin (as sulfate) antibacterial, gramicidin (antibacterial) & nystatin (antifungal)  - only available on prescription from your doctor.

CONCLUSIONS

Surolan appears to be the gold standard in triple action (anti inflammatory, anti bacterial and anti fungal ) chemical treatments for resolving secondary ear infections in dogs.  I have read that some people source Surolan on OS sites that don't have a prescription requirement.  But you will need to get from a trusted source and allow for postage and delivery time. You will need to know that you are treating a familiar secondary ear infection and that there are not other issues a vet should be addressing.

Otikfree Ear Drops has the same active ingredients in the same concentrations, but is made in India and is universally unavailable currently.

You can also attempt to source independently the THREE ' triple action' ingredients similar to surolan as described above, however most of these seem to be sold OS and still require a prescription.

You can buy some ear solutions that are anti bacterial and antifungal but lack the anti inflammatory chemicals meaning that they won't reduce your dog's pain while being treated and may not be effective as surolan because they lack this chemical.

You can use natural remedies or ones that attack bio film however they might also not be as useful to a dog that already has an active infection.

8th World Congress of Veterinary Dermatology said concerning dog ear medications that " Treatment options depend on the severity of lesions and the compliance of the owner/patient. Small focal areas can be treated with antifungal creams, wipes or ear drops. In multifocal or even generalized disease, topical therapy includes application of shampoos and rinses in mono- or combined preparations: chlorhexidin, ketoconazole, miconazole, climbazole, selenium sulfide, enilconazole, lime sulfur, acetid and boric acid.

When topical therapy is impractical or ineffective, oral antifugal treatment may be instituted. The most commonly used drugs are itraconazole, ketoconazole and terbinafine. "

Note

Poodle crosses have long ears that hand down, and cut off air to the ear canal. The ear canals can also get clogged with hair that should be twisted and plucked by professionals when the dog doesn't have an ear infection. Doing these things, plus regular Omega 3 usage dramatically reduces ear infections in many dogs.

If in doubt consult your vet.

Reference

Surolan independent testing: Effectiveness of Optic Product containing Miconazole, Polymyxin b and Prednisolene in the treatment of Canine Otitis Externa   

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surolan =  Miconazole nitrate 23 mg/mL   (= 2.3%) , prednisolone acetate 5 mg/mL  (0.5%) , polymyxin B sulfate 0.529 mg/mL. 

My dog required 7 ml per ear. 

Common antifungal medications include: Clotrimazole, Fluconazole, Ketoconazole, Miconazole, Econazole

Seperare ingredients that are used in some triple action dog ear medications:

1              Canesten Cream 1% 50g Topical  = Clotrimazole 1% w/w. Also contains: Benzyl alcohol 1% w/w as preservative.   = $12

2              1800petmeds  Prednisone  20 mg Tab (sold per tablet) 44 cents each.   For a 7 ml dose in Surolan terms the amount of prednisolene would be 35 mg.  Or approximately two 20 mg tablets crushed and put into solution.  Or  88 cents US per ear.

3              polymyxin B sulfate

 " Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Drops and Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment are prescription medications used by veterinarians for various conditions including the treatment of susceptible eye infections, scratches and allergies in dogs, "

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