Therapeutic Properties and Tolerance of Procaine and Phenazone Containing Ear Drops in Infants and Very Young Children

Abstract Since ear pain is often intolerable in very young children with acute otitis media (AOM), a safe pain reduction is indispensable both from the medical as well as from the ethical point of view. Methods: To confirm the safety and therapeutic properties of ear drops (Otalgan®) consisting of the short acting local anesthetic procaine hydrochloride (CAS 51-05-8) and the anti-inflammatory component phenazone (CAS 60-80-0), a multi-center, non-interventional post marketing surveillance (PMS) study was performed in 428 children (f/m: 45.6%/54.4%) aged between 0 and 6 years (mean 3.44 ys). Otalgia as the overall diagnostic criterion present in all children was allotted to otitis media in 398 (93%) and to otitis externa in 28 patients (6.5%), while in two patients, both diagnoses were documented. Results: No adverse drug reactions (ADR) to the target medication have been detected during the entire study. The evaluation of tolerance by the physicians (mean score 1.38) and by the children/parents (mean score 1.48) was in compliance with the absence of ADR. The drug tolerance was rated by the physicians in 99.8% of the cases as very good (62.2%; n = 266) or good (37.6%; n = 161). In one child (0.2%), the tolerance was evaluated by the physician as moderate. The judgement of parents revealed for all children either a very good (51.9%; n = 222) or good (48.1%; n = 206) evaluation of tolerance. The target medication was tolerated well, independent of the duration of treatment (2 to 10 days with a median of 5 days), of the daily dose and of the accumulated dose per treatment cycle, i. e. longer treatments and higher doses were not associated with a worsening of tolerance evaluations. Even in the highest dose class of over 100 drops per treatment cycle, no changes of tolerance could be revealed. As far as can be derived from non-controlled observational data, the results also confirm the known efficacy profile of the target medication in children. Under the treatment, the initial mean pain score of 2.33 was reduced by nearly 93% down to 0.17, accompanied by a corresponding normalization of the otoscopic findings of the ear canal and the tympanic membrane, and by the improvement of the general condition. In 95.3% of the children, the physicians rated the efficacy of the target medication as very good (n = 156; 36.4%) or good (n = 252; 58.9%) while in 14 patients (3.3%) the efficacy was scored as moderate, in 4 patients (0.9%) as minimal and in two patients as inadequate (0.5%). The results also demonstrate that with the use of the target medication for local symptomatic treatment of pain in the outer ear canal and in AOM in children, the use of antibiotics in most of the cases can be avoided. Conclusions: The findings are in full accordance with the results of former clinical studies, with positive evaluations of ototoxicity and with accumulated pharmacovigilance data showing that since introduction of the drug in 1911, no ADR have ever been reported in children. The study confirms that the target medication provides a safe and rapid pain reduction and improvement of inflammation in very young children suffering from painful acute inflammatory ear conditions.