How to prepare ear drops with polymyxin, bacitracin and hydrocortisone acetate?

Beforehand, I must note that this ear drop is not suitable for perforation of the eardrum. This is not only due to the presence of propylene glycol but also of unresolved particles. Therefore, we would be able to replace Memento hydrocortisone acetate by the same amount of prednisolone sodium phosphate (see question about ear drops with hydrocortisone 1% for middle ear  ), which is water soluble. But the presence of a high amount of polymyxin H (+) could cause complex formation with prednisolone phosphate (-). We have an example of Polydexa ear drops in which there is a combination of analogue constituents with a lower concentration of polymyxin B sulfate. The package leaflet prohibits the use of this ear drop in the perforation of the eardrum due to ototoxicity. Before applying Polydexa, the condition of the eardrum should be checked. In the case of a perforated eardrum, there is a risk of ototoxicity with Cochlear (deafness) and vestibular (equilibrium disorders) degradation. So if the client's remark is incorrect and if the formed moisture comes from an inflammation in the outer ear, this formula can be prepared. A good way of working should still be made on the point given that the doctor asks for a sterile preparation.

Conclusion: Everything stands or falls with whether or not pierced the eardrum!