Long-term management of recurrent otitis externa in dogs using a two-phase protocol involving ciprofloxacin-clotrimazole-betamethasone and topical hydrocortisone aceponate

BACKGROUND: Recurrent otitis (RO) is characterized by inflammatory or infectious processes in dogs with allergic skin diseases, accompanied by recurrent secondary bacterial and fungal infections. Dogs underwent a combined therapeutic approach for RO, assessing the effect of long-term management during the Stabilization Phase (SP) using a suspension containing ciprofloxacin, clotrimazole, and betamethasone, followed by management in the Proactive Phase (PP) with topical hydrocortisone aceponate (HCA) administration. A total of 45 dogs were evaluated, totaling 90 ears. All animals had a clinical history of bilateral RO with an erythematous-ceruminous clinical presentation, as indicated by the anamnesis, clinical, cytological, and otoscopic evaluations, with three or more relapse episodes of otitis per year. RESULTS: The SP management reduced bacterial infections and led to an increase in yeast occurrence. There was a decrease in severe otitis cases, while the incidence of moderate scores-Otitis Index Score-3 (OTIS-3) (3 and 4) increased, indicating the persistence of RO with significant changes. In the PP, the topical HCA solution demonstrated efficacy, showing a marked reduction in cytology and clinical assessment over 90 days, with no signs of recurrence or otitis persistence throughout the remaining period. The PP, using HCA, promoted improvement in cytological and clinical outcomes, with most dogs showing no recurrence of otitis. CONCLUSIONS: The likely favorable safety profile of HCA, its local anti-inflammatory effects, and its ability to avoid systemic side effects make it a promising therapeutic option for the long-term management of RO in dogs.