Anauran

Anauran is a combination drug that contains three active components:

1. Polymyxin B sulfate is an antibiotic that is commonly used to treat infections caused by gram-negative bacteria. Polymyxin B has a bactericidal effect by destroying the cell membranes of bacteria and preventing their growth and reproduction.
2. Neomycin sulfate is another antibiotic that is also used to treat infections caused by bacteria. Neomycin interferes with the synthesis of bacterial proteins, which leads to their death.
3. Lidocaine hydrochloride is a local anesthetic that is used to reduce pain during treatment of infections or procedures in the area where the drug is applied.

Anauran is commonly used to treat outer ear infections caused by bacteria such as Pseudomonas aeruginosa, Escherichia coli and other gram-negative organisms. It is administered as topical ear drops.

Indications Anaurana

1. Acute otitis externa (otitis externa) is an infection of the outer ear, often caused by bacterial pathogens. Anauran may be prescribed to treat acute otitis externa, especially if the infection is caused by gram-negative bacteria.
2. Ear infections - The drug may be used to treat other ear infections caused by bacteria, especially if they are gram-negative organisms.

Release form

Anauran is available as topical ear drops. The drops are usually supplied in bottles with a convenient dispenser for easy and accurate administration of the drug into the outer ear.

Pharmacodynamics

1. Polymyxin B sulfate: Polymyxin B is an antibiotic from the polymyxin group that has a bactericidal effect. It affects gram-negative bacteria, including Pseudomonas aeruginosa, Escherichia coli and others. The mechanism of action of polymyxin B is the disruption of the cytoplasmic membrane of bacteria, which leads to their death.
2. Neomycin Sulfate: Neomycin is also an antibiotic that inhibits protein synthesis in bacteria. It does this by binding neomycin to the 30S subunit of the bacterial ribosome, which prevents aminoacyl-tRNA from binding to mRNA, thereby inhibiting protein synthesis.
3. Lidocaine hydrochloride: Lidocaine is a local anesthetic that works by blocking sodium channels in nerve cells, preventing the transmission of pain signals. Anauran uses lidocaine to provide pain relief and relieve discomfort associated with ear infections.

Pharmacokinetics

1. Polymyxin B Sulfate and Neomycin Sulfate: When Anauran is administered topically to the outer ear, polymyxin B and neomycin sulfate can slowly penetrate the eardrum into the middle ear and further into the tissues where they can exert their antibacterial action. They are not usually absorbed into the bloodstream in sufficient quantities to be systemically effective, reducing the risk of systemic side effects.
2. Lidocaine hydrochloride: Lidocaine is usually rapidly absorbed through the mucous membranes into the ear. It acts quickly, providing local anesthesia and reducing pain in the ear cavity. After topical application, lidocaine is rapidly metabolized in the liver and excreted from the body through the kidneys.

Dosing and administration

1. Before using the drug, be sure to consult your doctor or pharmacist. They can give you individual recommendations based on your health condition and treatment needs.
2. Clean the ear of discharge and debris. You can use a soft cotton swab or tissue for this.
3. Place the required number of drops into the outer ear. To do this, tilt your head so that the ear is vertical and place a few drops inside the auricle.
4. After administering the drops, gently massage the area around the auricle. This will help distribute the medication evenly inside the ear.
5. Follow your doctor's instructions regarding frequency and duration of use. Typically, drops are prescribed several times a day for a specific period of time, which may vary depending on the nature of the infection and its response to treatment.
6. Do not exceed the recommended dose. Following the recommended dosage will help avoid side effects and overdoing it.
7. After use, close the bottle with the lid and keep it out of the reach of children.

Use Anaurana during pregnancy

1. Polymyxin B:

   • Polymyxin B may have neuromuscular blocking effects, which are potentially dangerous when used in high doses, especially in vulnerable populations such as pregnant women. Polymyxin B has been shown to cause respiratory paralysis when administered intravenously (Small, 1964).
   • Animal studies have shown that polymyxin B may interfere with normal embryonic development and increase the risk of congenital abnormalities when administered during pregnancy (Jaiswal et al., 2011).

2. Neomycin sulfate:

   • Neomycin may reduce estrogen excretion in pregnant women, which may affect the normal hormonal balance during pregnancy (Pulkkinen & Willman, 1973).
   • When applied topically, neomycin may cause contact sensitization, which may be a problem for some pregnant women (Booth et al., 1994).

3. Lidocaine hydrochloride:

   • Lidocaine is used as a local anesthetic and is considered relatively safe when used in moderate doses. However, its combination with other components such as polymyxin B and neomycin may require caution due to possible additive toxic effects (Wright & Collier, 1976).

Contraindications

1. Individual intolerance: Any of the components of Anauran may cause an allergic reaction in the patient. In the presence of a known allergy to these substances, the use of the drug is contraindicated.
2. Damaged eardrum: The use of topical ear drops, including Anauran, is contraindicated in the presence of a damaged eardrum, as this may facilitate the penetration of the drug into the middle ear and cause infection.
3. Acute purulent middle ear infection: In the presence of acute purulent middle ear infection, systemic antibiotic treatment may be required and the use of topical drops such as Anauran may not be sufficient.
4. Use of an intra-aural implant: The use of topical drops may be contraindicated in patients with intra-aural implants or other ear surgeries.
5. Children: For children, the use of drops should be carried out with special care and under the supervision of a doctor.
6. Pregnancy and breastfeeding: The use of Anauran during pregnancy and breastfeeding requires an assessment of the benefits and risks and should be carried out under the supervision of a physician.
7. Previous reactions to local anesthetics: If the patient has a known allergy or previous adverse reactions to local anesthetics such as lidocaine, the use of Anauran may be contraindicated.

Side effects Anaurana

1. Allergic reactions: Include skin rash, itching, hives, swelling of the face, throat or tongue, difficulty breathing and anaphylactic shock. If any allergic reactions occur, stop using the product immediately and seek medical attention.
2. Ear irritation: Temporary symptoms of ear irritation may occur, such as redness, itching, tingling, or discomfort in the ear cavity.
3. Hearing loss: Some patients may notice temporary hearing loss after using topical drops. This usually resolves on its own, but it is important to notify your doctor.
4. Gastrointestinal disorders: Rare cases of irritation or discomfort in the stomach or intestines may occur.
5. Systemic side effects: Although systemic absorption of active ingredients from topical application of Anauran is usually minimal, systemic side effects associated with antibiotics or local anesthetics are theoretically possible.
6. Hypersensitivity to the components of the drug: Individual reactions to one of the components of the drug may cause hypersensitivity, which will lead to various undesirable effects.

Overdose

Overdose of topical application of Anauran (ear drops) is unlikely due to low systemic absorption of the active components. However, in case of accidental ingestion of the drug or its use in large quantities, unwanted side effects are possible.

Signs of overdose may include increased or worsening side effects such as allergic reactions, irritation or redness of the skin in the ear area, as well as possible systemic effects associated with lidocaine (a local anesthetic) such as drowsiness, dizziness, arrhythmia, and even seizures.

Interactions with other drugs

1. Other topical ear medications: Using several topical medications at the same time may increase the risk of developing irritation or allergic reactions in the ear cavity. It is recommended to consult a doctor before using other ear medications simultaneously with Anauran.
2. Systemic Antibiotics: Since polymyxin B and neomycin, which are part of Anauran, are applied topically, their systemic interaction with other antibiotics is usually minimal. However, if the patient is taking systemic antibiotics for other infections, it is important to inform the doctor.
3. Local anesthetics: The use of lidocaine, which is part of Anauran, with other local anesthetics may increase the risk of toxic effects, especially when using high doses or with increased sensitivity to anesthetics.
4. Drugs that increase the risk of allergic reactions: If you are allergic to any components of Anauran or other drugs that increase the risk of allergic reactions, you should be careful when using them simultaneously to avoid the development of allergic complications.