Evidence-based veterinary dermatology:: a systematic review of interventions for treatment of Pseudomonas otitis in dogs

The efficacy and safety of pharmacological interventions to treat canine Pseudomonas otitis externa and media were evaluated based on the systematic review of clinical trials published between 1967 and 2006. Clinical trials were included if Pseudomonas species were cultured from the ears of dogs with otitis externa or otitis media prior to treatment, and if the outcome of these interventions was reported at the end of the study. Studies were compared with regard to design characteristics (randomization generation and concealment, masking, intention-to-treat analyses), benefit (microbiological and/or clinical resolution of the Pseudomonas otitis), and adverse effects. Ten trials reporting data on 162 patients and 13 different pharmacological interventions were identified. Based on the accepted criteria for quality of evidence, there is insufficient evidence for or against recommending the use of any of these treatments for Pseudomonas otitis in dogs. This is largely because there is only one trial supporting the use of each treatment option and none were randomized controlled trials. Future studies need to be prospective, randomized, blinded and controlled; designed to evaluate pharmacological interventions for otitis regardless of the infective organism; have appropriate statistical advice on recruitment numbers, the power of the study and appropriate statistical analysis; include details of underlying conditions and concomitant treatments; and be designed such that inclusion criteria include microbial culture and antimicrobial sensitivity, and outcome assessments include clinical examination, cytology and microbial culture.