Drug Guide
Hydrocortisone and Acetic Acid
Classification
Therapeutic: Anti-inflammatory, Antiseptic
Pharmacological: Glucocorticoid corticosteroid with antiseptic properties
FDA Approved Indications
- Otitis externa (ear infections)
- Inflammation and infection of external auditory canal
Mechanism of Action
Hydrocortisone reduces inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Acetic acid creates an acidic environment that inhibits bacterial and fungal growth.
Dosage and Administration
Adult: Apply 3-4 drops into the affected ear(s) twice daily for up to 7 days.
Pediatric: Use as directed by a physician; generally similar dosing, but cautious use in children under 2 years.
Geriatric: No specific adjustments, but monitor for sensitivity.
Renal Impairment: No specific adjustments needed.
Hepatic Impairment: No specific adjustments needed.
Pharmacokinetics
Absorption: Minimal systemic absorption when used topically in ear canal.
Distribution: Locally within ear tissues.
Metabolism: Hydrocortisone undergoes hepatic metabolism upon systemic absorption.
Excretion: Metabolites excreted in urine.
Half Life: Hydrocortisone's plasma half-life approximately 8-12 hours.
Contraindications
- Perforated eardrum or known hypersensitivity to corticosteroids or acetic acid.
Precautions
- Use with caution in patients with active or a history of tympanic membrane perforation; prolonged use may lead to local or systemic effects.
Adverse Reactions - Common
- Burning, stinging sensation in the ear (Common)
- Itching or irritation (Common)
Adverse Reactions - Serious
- Allergic reactions (rash, swelling) (Rare)
- Perforation of tympanic membrane (if perforation exists) (Rare)
Drug-Drug Interactions
- None significant when used topically in ear.
Drug-Food Interactions
- None
Drug-Herb Interactions
- None
Nursing Implications
Assessment: Assess for signs of infection, perforation, or hypersensitivity prior to use.
Diagnoses:
- Risk for infection
- Impaired hearing
Implementation: Apply drops as directed, keeping the tip clean and avoiding contamination.
Evaluation: Monitor for symptom relief and adverse effects.
Patient/Family Teaching
- Use the medication exactly as prescribed.
- Avoid contaminating the dropper tip.
- Report any worsening symptoms or signs of allergic reaction.
- Do not use if the eardrum is perforated unless directed by a healthcare provider.
Special Considerations
Black Box Warnings:
- Prolonged use may cause local or systemic corticosteroid side effects.
Genetic Factors: None specific.
Lab Test Interference: None reported.
Overdose Management
Signs/Symptoms: Rare systemic steroid overdose—may include symptoms of steroid excess such as weight gain, swelling, hypertension.
Treatment: Discontinue use and provide supportive care. Systemic corticosteroid overdose is unlikely with topical ear use.
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable until expiration date on the package.