Abstract:
Disclosed are compositions containing a lactoferrin hydrolysate, glycerophosphorylinositol or salts thereof and/or verbascoside which are useful for the prevention and/or treatment of dermatological, otological and stomatological inflammations and infections, in particular in the veterinary sphere.

Description:
[0001]    The present invention relates to compositions comprising a lactoferrin hydrolysate, glycerophosphorylinositol or salts thereof, and/or verbascoside or extracts containing it. 
         [0002]    The compositions according to the invention are useful for the prevention and/or treatment of dermatological, otological and stomatological inflammations and infections, in particular in the veterinary sphere. The compositions according to the invention can also be employed in the human pharmaceutical, animal feed, nutraceutical and cosmetic fields, and can be used in medical devices. 
       STATE OF THE ART 
       [0003]    Ear, skin and stomatological disorders in humans and animals, especially pets such as dogs and cats, present therapeutic problems that are not easy to solve. Said disorders are mainly due to infections supported by bacteria, fungi or parasites, and conventional pharmacological treatments based on antibiotics, antifungals or pesticides, possibly combined with anti-inflammatories, analgesics or other medicaments, do not always enable the disorder to be treated satisfactorily. 
         [0004]    The primary causes of otitis externa, which has a prevalence of 15-20% in dogs and 6-7% in cats, are allergies or hypersensitivity (atopy, allergic reactions to food, allergic dermatitis caused by fleas), foreign bodies with subsequent aspecific bacterial superinfection, bacterial infection ( Bacillus  spp,  Pseudomonas  spp,  E. coli, Enterococcus  spp,  Proteus  spp,  Staphylococcus intermedius  and  Staphylococcus aureus, Streptococcus canis  and  Streptococcus  spp,  Klebsiella  spp), and yeast infection ( Candida  spp,  Malassezia pachydermatis , and more rarely  M. furfur, M. globosa  and  M. sympodialis ). 
         [0005]    Otitis is usually treated by cleaning of the auditory meatus and topical treatment, followed by systemic treatment if necessary. Products based on glucocorticoids (hydrocortisone, predniso lone, triamcinolone, betamethasone, dexamethasone or fluocinolone), antibiotics (neomycin, chloramphenicol, gentamicin, amikacin or ciclosporin) and antifungals (ketoconazole, miconazole or amphotericin B2) in an aqueous or oily carrier are normally used for topical treatment. 
         [0006]    Disinfectants such as povidone-iodine and chlorhexidine are also used. 
         [0007]    If mites are present an antiparasitic such as amitraz, fipronil or ivermectin is used. 
         [0008]    For systemic treatment of advanced otitis, antibiotics such as trimethoprim-sulphasalazine, clindamycin, cephalexin and enrofloxacin are used (Jacobson, Tydskr. S. Afr. vet. Ver., 73(4): 162-170, 2002). 
         [0009]    Microbial skin diseases, which are more frequent in dogs than cats, include superficial bacterial dermatitis, wherein the infection does not go beyond the basal membrane (intertrigo, bacterial folliculitis, mucocutaneous pyodermitis and bacterial overgrowth syndrome), and deep bacterial dermatitis (furunculosis, cellulitis), wherein the infection also involves the dermis and/or the subcutaneous tissue. 
         [0010]    A form of infection which is frequent in dogs is “pyotraumatic dermatitis”, also known as “hot spot”. 
         [0011]    The bacterial strains most frequently encountered in these infections are  Staphylococcus intermedius , and  Staphylococcus  spp,  Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa  and  Pseudomonas  spp,  Bacillus  spp and  Streptococcus  spp. 
         [0012]    Other micro-organisms commonly found on the skin are yeasts of the genus  Malassezia  (especially  Malassezia pachydermatis ) and  Candida , which are frequently considered to be co-pathogens in bacterial dermatitis. 
         [0013]    In cats, the strains most frequently isolated in bacterial dermatitis are  Staphylococcus intermedius, Staphylococcus aureus  and  Staphylococcus simulans . Yeasts of the genus  Malassezia  are also frequently found in this animal species. 
         [0014]    Bacterial dermatitis is typically treated with oral antibiotics. Treatment of superficial and deep pyodermitis requires systemic administration of antimicrobials, and topical application of antibacterial agents. Amoxicillin/clavulanic acid and cephalosporins (cephalexin, cefadroxil and cephalothin) are often used to treat skin infections (Sudhakara Reddy et al., Hindawi Publishing Corporation ISRN Veterinary Science, 2014). 
         [0015]    An additional treatment includes baths with an antimicrobial shampoo 3 times a week. The antimicrobial agents most commonly used include benzoyl peroxide, chlorhexidine, iodine and triclosan. 
         [0016]    Additional topical treatment comprises the application of fatty ointments, for example based on mupirocin (Dowling, Can Vet J 37, November 1996). 
         [0017]    Finally, as regards stomatitis, which is normally caused by the accumulation of bacterial plaque on the teeth and periodontium, the bacterial species most commonly found (76%) in periodontal disease are  Porphyromonas denticanis, P. gulae  and  P. salivae , which are Gram-negative anaerobic bacteria. In addition to said three species, hundreds of other bacterial species can be found in the saliva of dogs and cats, whether healthy or suffering from gingivostomatitis. 
         [0018]    The treatment involves products based on chlorhexidine, essential oils, triclosan, fluorides, oxygenating agents, quaternary ammonium compounds, enzymes and amino-alcohol substitutes (“Periodontal Disease and Diet in Domestic Pets”, Gorrel, American Society for Nutritional Sciences, 1998) or the administration of corticosteroids or non-steroidal anti-inflammatory drugs (Yi-Ping Hung, et al., Vet J. Jun. 10, 2014) to reduce the inflammation, possibly combined with antibiotics (Corbee et al., J Anim Physiol Anim Nutr (Berl). August; 96(4):671-80, 2012). 
         [0019]    It usually gives short-term results, but the long-term results are unsatisfactory in the absence of surgery. In the case of chronic stomatitis, oral cyclosporin is administered with the aim of reducing the gum inflammation, often after surgery (Lommer, J Vet Dent. Spring; 30(1):8-17, 2013). 
         [0020]    The need is therefore felt for new treatments which are more effective than the conventional treatments, involve fewer toxic or side effects, are convenient to use, and are applicable to different animal species and different organs, tissues and mucous membranes. 
         [0021]    This need has been met by combining a lactoferrin hydrolysate with glycerophosphorylinositol or salts thereof and/or verbascoside or extracts containing it. 
         [0022]    The use of lactoferrin hydrolysates to treat joint, cartilage and skeletal disorders was disclosed in WO 2007/043900. Topical formulations of lactoferrin are disclosed in WO 2012/153301 and EP 2298338. U.S. Pat. No. 5,834,424 discloses the use of lactoferrin to inhibit the penetration of  S. pyogenes  and  S. aureus  into host cells. 
         [0023]    EP 1581044 discloses dental sticks for pets which can contain lactoferrin among numerous other ingredients. 
         [0024]    Verbascoside, a caffeic acid glycoside present in various plants belonging to the Oleaceae group, possesses antibacterial, anti-inflammatory, immunomodulating, antitumoral, hypertensive, anti-hepatotoxic and painkilling activity. 
         [0025]    Glycerophosphoinositol, a metabolite of phosphoinositide, has been studied as an immune response modulator, and proposed for the treatment of septic shock (WO 20142053642). 
     
    
     DESCRIPTION OF THE INVENTION 
       [0026]    It has now been found that the combination of lactoferrin hydrolysates with glycerophosphoinositol and/or verbascoside or extracts containing it presents synergic effects which can be conveniently exploited to treat various types of infection in the veterinary field, especially in the treatment of ear, skin and stomatological disorders. 
         [0027]    The subject of the invention is therefore compositions containing a lactoferrin hydrolysate, glycerophosphorylinositol or salts thereof, and/or verbascoside or extracts containing it. 
         [0028]    The invention also relates to said compositions for use in the treatment of erythematous and ceruminous otitis externa in dogs and cats, dermatological treatment of skin infections of microbial origin in dogs and cats, and stomatological treatment of inflammations of the oral cavity, especially those affecting the gums (gingivitis and periodontitis), in dogs and cats. 
         [0029]    The compositions according to the invention may contain a lactoferrin hydrolysate and glycerophosphorylinositol or salts thereof, or a lactoferrin hydrolysate and verbascoside or extracts containing it, or a lactoferrin hydrolysate, glycerophosphorylinositol or salts thereof, and verbascoside or extracts containing it. 
         [0030]    Compositions containing all three active ingredients (lactoferrin hydrolysate, glycerophosphoinositol and salts thereof and verbascoside) are preferred. Compositions only containing verbascoside and lactoferrin hydrolysate are equally preferred. 
         [0031]    The compositions according to the invention will be formulated with suitable excipients in forms suitable for topical or oral administration. 
         [0032]    Examples of suitable forms include solid forms (such as tablets, pills, rigid and soft capsules, powders, granulates and pastes for oral use), semisolid forms (such as creams, ointments, gels, fatty ointments, lubricants, pastes, emulsions and microemulsions and pastes for topical use), and liquid forms (such as syrups, shampoos, lotions, ampoules and drops). 
         [0033]    In the topical formulations, the concentration by weight of the individual active ingredients falls within the following intervals:
       Lactoferrin hydrolysate: 0.0005-15%;   Glycerophosphoinositol or salts thereof (solution containing at least 4% L-α-glycero-phospho-D-myo-inositol choline): 0.0020%-10%;   Verbascoside: 0.0020%-15%.       
 
         [0037]    The oral formulations will be suitable for daily administration of the active ingredients at doses falling within the following intervals per approximately ten kg of weight of the animal treated:
       Lactoferrin hydrolysate: 0.005 mg to 5 grams;   Glycerophosphoinositol: 0.005 mg to 5 grams;   Verbascoside: 0.005 mg to 5 grams.       
 
         [0041]    Lactoferrin hydrolysate is known and available on the market or can be prepared by known methods, for example by treating lactoferrin with proteolytic enzymes. An example of lactoferrin hydrolysate which is well known, has been thoroughly studied and is available on the market is lactoferricin (Wakabayashi H, Takase M, Tomita M. Curr Pharm Des. 2003; 9(16):1277-87 ; Dairy Science  &amp;  Technology  94: 181-193. 2013; Eliassen L T, et al., Anticancer Res. 2002 September-October; 22(5):2703-10. 
         [0042]    Verbascoside can be present as such or in the form of an extract of  Olea europaea, Syringa vulgaris  or other genera, species and varieties or cultivars containing them. Said ingredients are also available on the market. 
         [0043]    Glycerophosphoinositol or the salts thereof are known and available on the market. The lysine salt is preferred. 
         [0044]    The topical formulations according to the invention will be administered two or three times a day, in quantities ranging from 0.5 to 10-20 ml or more, depending on the surface area to be treated. 
         [0045]    In the case of oral administration, the dose will depend on a number of factors such as the animal&#39;s weight and the type and severity of the disorder, and will be determined by the veterinary surgeon case by case. Approximately, however, the doses administered will be 0.5 mg/kg/day to 400 mg/kg/day of lactoferrin hydrolysate, 1 mg/kg/day to 400 mg/kg/day of verbascoside or the equivalent of an extract thereof, and 1 mg/kg/day to 400 mg/kg/day of glycerophosphoinositol or the equivalent of a salt thereof. 
         [0046]    The antimicrobial activity of the active ingredients of the composition according to the invention has been evaluated on  Malassezia pachydermatis  DSM 6172,  Staphylococcus intermedius  ATCC 29663,  Pseudomonas aeruginosa  ATCC 27853,  Staphylococcus aureus  ATCC 29213,  Escherichia coli  ATCC 25922 and  Malassezia furfur  DSM 6170 using in vitro susceptibility tests with the antimicrobial dilution method (Clinical and Laboratory Standards Institute—CLSI—protocols), with which it was possible to determine the MIC (Minimum Inhibitory Concentration) for each compound. 
         [0047]    For all the tests performed, there was a positive control of antifungal activity using fluconazole (for  Malassezia ) and ceftriaxone (for the bacterial strains) and a negative control (absence of the compounds) wherein correct microbial growth was evaluated. 
         [0048]    The antimicrobial activity of the combinations of the various compounds towards the micro-organisms against which the individual compounds had proved active was also evaluated. 
         [0049]    The results demonstrated the synergy of the ingredients of the composition according to the invention. 
         [0050]    The antimicrobial activity of lactoferrin (Lf), lactoferrin hydrolysate (Lf hydro), extract of  Olea europaea  and derivatives thereof (verbascoside) was evaluated on  S. aureus  ATCC 29213. 
         [0000]    
       
         
               
               
               
               
               
             
           
               
                   
                   
               
               
                   
                   
                   
                 Lf hydro 
                 Verbascoside 
               
               
                   
                   
                 Lf (g/L) 
                 (g/L) 
                 (g/L) 
               
               
                   
                   
               
             
             
               
                   
                 
                   S. 
                   aureus 
                 
                 20.00 
                 2.00 
                 3.0 
               
               
                   
                   
               
             
          
         
       
     
         [0051]    The antimicrobial activity of the various combinations of compounds was also determined: 
         [0000]    
       
         
               
               
               
             
               
               
               
             
           
               
                   
               
               
                   
                 LF + 
                 LF hydro + 
               
               
                   
                 verbascoside 
                 verbascoside 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 
                   S. 
                   aureus 
                 
                 SYN 1   
                 SYN 2   
               
               
                   
               
               
                 Key: 
               
               
                 SYN = synergy; the type of interaction was established by calculating FIC index  (MIC A in combination /MIC A  + MIC B in combination /MIC B ): 
               
               
                   1 -&gt; FIC index  = 0.3; 
               
               
                   2 -&gt; FIC index  = 0.5 
               
             
          
         
       
     
         [0052]    The experimental data obtained demonstrate the synergic action of the compounds when combined with one another. 
         [0053]    Examples of formulations according to the invention, and the results of an in vivo trial, are set out below. Glycerophosphoinositol is present in the formulations as a 4% aqueous solution. The  Syringa vulgaris  extract has a verbascoside content of 10% by weight. 
       Example 1: Ear Gel 
       [0054]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Glycerin 
                 11.49 
                 g 
               
               
                   
                 Dipropylene glycol 
                 70.5 
                 g 
               
               
                   
                 Propylene glycol 
                 10.3334  
                 g 
               
               
                   
                 20% chlorhexidine digluconate 
                 0.25 
                 g 
               
               
                   
                 Glycolic extract of propolis 
                 0.5  
                 g 
               
               
                   
                 Lavender essence 
                 0.5  
                 g 
               
               
                   
                 Butyl hydroxytoluene 
                 0.01 
                 g 
               
               
                   
                 Pharmaceutical lactic acid 
                 2.6666 
                 g 
               
               
                   
                 Glycolic extract of aloe 
                 0.5  
                 g 
               
               
                   
                 Salicylic acid 
                 0.25  
                 g 
               
               
                   
                 Technical oleic acid 
                 3 
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 2.4 
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 2.2  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 1.6 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 2: Foam for External Use 
       [0055]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 18b-glycyrrhetic acid 
                 0.4  
                 g 
               
               
                   
                 Purified water 
                 62.56  
                 g 
               
               
                   
                 Cocoyl diethanolamide 
                 2 
                 g 
               
               
                   
                 Dipropylene glycol 
                 20  
                 g 
               
               
                   
                 Polysorbate 20 
                 3  
                 g 
               
               
                   
                 Hydrogenated castor oil (40)OE 
                 5 
                 g 
               
               
                   
                 Melaleuca essence 
                 3 
                 g 
               
               
                   
                 Disodium EDTA 
                 0.02 
                 g 
               
               
                   
                 20% chlorhexidine digluconate 
                 2.5 
                 g 
               
               
                   
                 Vitamin F ethyl ester 
                 1  
                 g 
               
               
                   
                 Butyl hydroxytoluene 
                 0.02  
                 g 
               
               
                   
                 Glycolic extract of aloe 
                 0.5  
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 1.8  
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 2.6  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 2 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 3: Shampoo for External Use 
       [0056]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Purified water 
                 43.69  
                 g 
               
               
                   
                 Cocoyl diethanolamide 
                 3  
                 g 
               
               
                   
                 Cocamidopropyl betaine 
                 5  
                 g 
               
               
                   
                 Propylene glycol 
                 5  
                 g 
               
               
                   
                 Imidazolidinyl urea 
                 0.2 
                 g 
               
               
                   
                 Lauryl ether sodium sulphate (Texapon NSO UP) 
                 30 
                 g 
               
               
                   
                 Methyl + methylchloro-isothiazolinone 
                 0.1  
                 g 
               
               
                   
                 PEG-7-Glyceryl Cocoate 
                 4 
                 g 
               
               
                   
                 Undecylenic polyglycol 
                 2  
                 g 
               
               
                   
                 Polysorbate 20 
                 2  
                 g 
               
               
                   
                 Tricosolfan 
                 4  
                 g 
               
               
                   
                 Lavender essence 
                 0.5 
                 g 
               
               
                   
                 Butyl hydroxytoluene 
                 0.01 
                 g 
               
               
                   
                 Salicylic acid 
                 0.5  
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 1.6 
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 2.9  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 2.3 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 4: Mousse for External Use 
       [0057]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Citric acid monohydrate 
                 0.37 
                 g 
               
               
                   
                 Purified water 
                 86.94  
                 g 
               
               
                   
                 Cocamidopropyl betaine 
                 3 
                 g 
               
               
                   
                 Dipropylene glycol 
                 0.5  
                 g 
               
               
                   
                 Imidazolidinyl urea 
                 0.2  
                 g 
               
               
                   
                 Methyl + methylchloro-isothiazolinone 
                 0.1 
                 g 
               
               
                   
                 Undecylenic polyglycol 
                 1  
                 g 
               
               
                   
                 Disodium phosphate dodecahydrate 
                 5.89 
                 g 
               
               
                   
                 Vitamin E acetate 
                 0.1  
                 g 
               
               
                   
                 Hydrogenated castor oil (40)OE 
                 1 
                 g 
               
               
                   
                 Vitamin F ethyl ester 
                 0.1 
                 g 
               
               
                   
                 Lavender essence 
                 0.3 
                 g 
               
               
                   
                 Salicylic acid 
                 0.5  
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 0.8  
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 3.1  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 2.5 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 5: Cream for External Use 
       [0058]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Glycerin 
                 2  
                 g 
               
               
                   
                 Cetyl stearyl alcohol 
                 3.6  
                 g 
               
               
                   
                 Cetyl stearyl alcohol (12) OE 
                 2 
                 g 
               
               
                   
                 Sodium cetyl stearyl sulphate 
                 0.4 
                 g 
               
               
                   
                 Isopropyl myristate 
                 3  
                 g 
               
               
                   
                 Sodium polyacrylate 
                 0.2 
                 g 
               
               
                   
                 Lactic acid 
                 0.1  
                 g 
               
               
                   
                 BHT 
                 0.02 
                 g 
               
               
                   
                 Methyl-methylchloro-isothiazolinone 
                 0.1 
                 g 
               
               
                   
                 Imidazolidinyl urea 
                 0.3  
                 g 
               
               
                   
                 Lavender essence 
                 0.1  
                 g 
               
               
                   
                 Purified water 
                 88.18  
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 0.5  
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 3.1  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 1.7 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 6: Stomatological Gel 
       [0059]      
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Octanol 
                 10 
                 g 
               
               
                   
                 Purified water 
                 26.78 
                 g 
               
               
                   
                 Butyl hydroxytoluene 
                 0.02 
                 g 
               
               
                   
                 Dipropylene glycol 
                 60  
                 g 
               
               
                   
                 Hydroxypropylcellulose (Klucel MF) 
                 2 
                 g 
               
               
                   
                 Imidazolidinyl urea 
                 0.2 
                 g 
               
               
                   
                 Perfume: Victory 6B/650 
                 1 
                 g 
               
               
                   
                 Lactoferrin hydrolysate 
                 2.4 
                 g 
               
               
                   
                   Syringa   vulgaris  extract 
                 0.9  
                 g 
               
               
                   
                 Glycerophosphoinositol lysine salt 
                 1.5 
                 g 
               
               
                   
                   
               
             
          
         
       
     
       Example 7: Clinical Trial on 10 Dogs Suffering from Ceruminous Otitis Externa 
       [0060]    4 to 8 drops per ear of the formulation described in example 1 were administered twice a day to the animals studied (one drop being equivalent to about 0.05 ml). 
         [0061]    The animals were selected according to good clinical practice (http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/10/WC500004343.pdf) and only included in the study when the owner&#39;s informed consent had been obtained. 10 dogs suffering from recurrent erythematous and ceruminous otitis were selected. 
         [0062]    Dogs of different breeds and genders, aged between 2 and 10 years, with the following characteristics, were included in the study:
       1. More than three episodes of otitis in the last 18 months;   2. Otoscopic examination compatible with erythematous and ceruminous otitis;   3. Cytological examination compatible with overgrowth of bacteria (number of bacteria&gt;10 to 40/HPF) and/or  Malassezia  (number of yeasts&gt;10 to 40/HPF), presence of keratinocytes and absence of neutrophil granulocytes and macrophages;   4. In the event of severe pain and handling difficulty, the dog was given 1 mg/kg of oral prednisolone once a day for three days, and its inclusion in the study was reconsidered after an examination 48 hours after discontinuance of the treatment;   5. The owner&#39;s agreement to take the animal for check-ups on the established dates.       
 
         [0068]    Dogs that had received systemic or topical antibiotic or antifungal ear treatments with ear cleansers in the last 7 days were excluded from the trial. Dogs suffering from otitis caused by parasites (otodectic mange, demodectic mange), foreign bodies, tumours (e.g. polyps blocking the meatus), chronic purulent idiopathic hyperplastic polypoid otitis, and/or otitis media, were also excluded. 
         [0069]    At the time of selection (VS) the dogs presented mono- or bilateral otitis and met the inclusion criteria. An otoscopic and cytological examination of the cerumen was conducted. If the otoscopic examination and cytological results were compatible with bacterial overgrowth and/or  Malassezia , a bacteriological test was conducted, and the selected animal was included in the study (inclusion visit VI): 
         [0070]    The following tests were conducted at the inclusion visit (VI): 
         [0071]    Evaluation of the condition of the auricle and the external auditory meatus; 
         [0072]    Cytological test of cerumen; 
         [0073]    Sampling of cerumen for bacteriological culture test; 
         [0074]    Completion of modified CADESI form and VAS. 
         [0075]    The examinations were repeated with the same data collection pattern every week for three weeks (V7, V15, V21). Samples for the bacteriological culture test were only taken at VI and VF. 
         [0076]    Cerumen samples were taken from the external auditory meatus with a cotton bud. The samples collected were immediately seeded on plates of Columbia Agar Base (with the addition of 5% sheep blood) and incubated at +37° C. for 24-48 h. The colonies which, due to their morphology, Gram and catalase, appeared to belong to the genus  Staphylococcus  spp., were then seeded on Mannitol Salt Agar (Oxoid®) for selective growth of staphylococci, and on a chromogenic medium specific for methicillin-resistant strains (MRSA®, bioMérieux, France). All the other isolates were subjected to Gram staining and subsequent preliminary identification tests (catalase, oxidase and motility) and then, depending on the first indications obtained, seeded in further culture media: MacConkey; Columbia CNA,  Pseudomonas  Agar Base, Sabouraud and chromogenic media selective for the KES group ( Klebsiella, Enterobacter, Serratia ). After isolation in purity, the strains were identified with the use of biochemical/enzyme galleries (API®—bioMérieux, France). To evaluate antibiotic resistance, the bacterium was subjected to the agar diffusion test (Kirby-Bauer method) using Muller Hinton agar (Oxoid®) according to the CLSI indications and classified, depending on the measurement of the inhibition halo diameter, as sensitive, resistant or intermediate according to the protocol of the National Committee on Clinical Laboratory Standards, on the basis of the manufacturer&#39;s instructions (Oxoid®, Ati, BD). Nine of the antibiotics most frequently used to treat otitis in veterinary medicine were tested simultaneously. 
         [0077]    SPSS software (version 19; SPSS Inc., Chicago, Ill., USA) was used for the statistical analysis. 
         [0078]    Summary of Results Obtained in 7 Cases 
         [0000]    
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Animal data and clinical diagnosis 
               
             
          
           
               
                 Case 
                 Breed 
                 Gender 
                 Age 
                 Clinical diagnosis 
               
               
                   
               
               
                 1 
                 French  
                 F 
                 8a 
                 Recurrent monolateral  
               
               
                   
                 bulldog 
                   
                   
                 ceruminous otitis with stenosis 
               
               
                 2 
                 Mongrel 
                 F 
                 4a 
                 Recurrent bilateral ceruminous  
               
               
                   
                   
                   
                   
                 otitis 
               
               
                 3 
                 Cocker  
                 F 
                 5a 
                 Recurrent monolateral  
               
               
                   
                 spaniel 
                   
                   
                 erythematous otitis 
               
               
                 4 
                 Mongrel 
                 F 
                 5a 
                 Recurrent monolateral  
               
               
                   
                   
                   
                   
                 erythematous otitis 
               
               
                 5 
                 Mongrel 
                 F 
                 13a  
                 Recurrent bilateral erythematous 
               
               
                   
                   
                   
                   
                 ceruminous otitis with stenosis 
               
               
                 6 
                 Fox terrier 
                 M 
                 7a 
                 Recurrent bilateral erythematous 
               
               
                   
                   
                   
                   
                 ceruminous otitis 
               
               
                 7 
                 German  
                 M 
                 5a 
                 Recurrent monolateral  
               
               
                   
                 shepherd 
                   
                   
                 erythematous ceruminous otitis 
               
               
                   
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Variation in CADESI scores 
               
             
          
           
               
                   
                 Case 
                 T0 
                 T7 
                 T14 
                 T21 
               
               
                   
                   
               
             
          
           
               
                   
                 1 
                 4 
                 3 
                 2 
                 2 (without treatment) 
               
               
                   
                 2 
                 0 
                 0 
                 0 
                 0 
               
               
                   
                 3 
                 11 
                 3 
                 4 
                 3 
               
               
                   
                 4 
                 10 
                 2 
                 2 
                 2 
               
               
                   
                 5 
                 42 
                 24 
                 21 
                 21 
               
               
                   
                 6 
                 10 
                 6 
                 6 
                 N/R 
               
               
                   
                 7 
                 17 
                 6 
                 6 
                 N/R 
               
               
                   
                   
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Variation in EAM grading 
               
             
          
           
               
                   
                 Case 
                 T0 
                 T7 
                 T14 
                 T21 
               
               
                   
                   
               
             
          
           
               
                   
                 1 
                 2 
                 3 
                 2 
                 1 
               
               
                   
                 2 
                 4 
                 0 
                 0 
                 0 
               
               
                   
                 3 
                 4 
                 7 
                 4 
                 0 
               
               
                   
                 4 
                 12 
                 6 
                 4 
                 4 
               
               
                   
                 5 
                 28 
                 16 
                 16 
                 16 
               
               
                   
                 6 
                 16 
                 2 
                 2 
                 N/R 
               
               
                   
                 7 
                 10 
                 10 
                 8 
                 N/R 
               
               
                   
                   
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
               
               
             
               
               
               
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Variation in cytological examination of material taken from EAM 
               
             
          
           
               
                 Case 
                 T0 
                 T7 
                 T14 
                 T21 
               
               
                   
               
             
          
           
               
                 1 
                 Corneocytes &gt;20 HPF 
                 &lt;5  
                 HPF 
                 5-10  
                 HPF 
                 10-20  
                 HPF 
               
               
                   
                 Cocci/rods, 20-30 HPF 
                 10-20  
                 HPF 
                 10-20  
                 HPF 
                 20-30  
                 HPF 
               
             
          
           
               
                   
                 ( Proteus vulgaris    
                 ( Proteus   
                   
                 ( S. interm ) 
               
               
                   
                 present) 
                 absent) 
                   
                   
               
             
          
           
               
                 2 
                 Corneocytes 10-20 HPF 
                 &lt;5  
                 HPF 
                 &lt;5  
                 HPF 
                 &lt;5  
                 HPF 
               
             
          
           
               
                   
                 Cocci/rods 20-30 HPF 
                 None 
                 None 
                 None 
               
               
                   
                 Malassezia 10-20 HPF 
                 None 
                 None 
                 None 
               
             
          
           
               
                 3 
                 Corneocytes 5-10 HPF 
                 &lt;5  
                 HPF 
                 None 
                 &lt;5  
                 HPF 
               
             
          
           
               
                   
                 Cocci and Malassezia  
                 10-20  
                 HPF 
                 None 
                 None 
               
             
          
           
               
                   
                 10-20 HPF 
                   
                   
                   
               
             
          
           
               
                 4 
                 Corneocytes 10-20 HPF 
                 &lt;5  
                 HPF 
                 &lt;5  
                 HPF 
                 &lt;5  
                 HPF 
               
             
          
           
               
                   
                 Cocci and Malassezia  
                 Cocci  
                 None 
                 None 
               
             
          
           
               
                   
                 20-30 HPF 
                 10-20  
                 HPF 
                   
                   
               
             
          
           
               
                 5 
                 Corneocytes 10-20 HPF 
                 10-20  
                 HPF 
                 &lt;5  
                 HPF 
                 &lt;5  
                 HPF 
               
             
          
           
               
                   
                 Cocci 20-30 HPF 
                 10-20  
                 HPF 
                 10-20  
                 HPF 
                 Cocci  
               
             
          
           
               
                   
                 Rods 10-20 HPF 
                   
                   
                 10-20  
                 HPF 
               
             
          
           
               
                 6 
                 Corneocytes 10-20 HPF 
                 5-10  
                 HPF 
                 5-10  
                 HPF 
                 N/R 
               
             
          
           
               
                   
                 Cocci/rods 20-30 HPF 
                 Cocci  
                 Cocci  
                 N/R 
               
             
          
           
               
                   
                   
                 10-20  
                 HPF 
                 10-20  
                 HPF 
                   
               
               
                 7 
                 Corneocytes 10-20 HPF 
                 5-10  
                 HPF 
                 5-10  
                 HPF 
                 N/R 
               
               
                   
                 Cocci 30-40 HPF 
                 20-30  
                 HPF 
                 20-30  
                 HPF 
                 N/R 
               
             
          
           
               
                   
                 Rods 10-20 HPF 
                 10-20  
                 HPF 
                 None 
                   
               
               
                   
                 Malassezia 10-20 HPF 
                 10-20  
                 HPF 
                 None 
               
               
                   
               
             
          
         
       
     
         [0079]    The clinical trial confirmed the efficacy of the composition in the treatment of disorders caused by the micro-organisms investigated, including particularly resistant pathogens such as Proteus (case 1).