Topical Antibiotic Ear Drops: Are They Safe?

S. Pappas; T.P. Nikolopoulos; S. Korres; G. Papacharalampous; A. Tzangarulakis; E. Ferekidis

Disclosures

Int J Clin Pract. 2006;60(9):1115-1119. 

In This Article

Summary and Introduction

A discharging ear is a very common condition for the general practitioner and the ENT surgeon. Oral and intravenous antibiotics have potential complications, are costly, and exhibit increasing resistance. This study explores the advantages and disadvantages of all common otic preparations and compares effectiveness, safety, cost and complication rates. In chronic otitis media (chronic discharging ears), topical antibiotics seem to be the treatment of choice by comparison with oral or intravenous antibiotics. Cultures and antibiograms do not correspond directly to clinical efficacy, as laboratory determination of resistance does not take into account the high concentration of antibiotics in local preparations. It is safer to use quinolone drops as a first-line treatment, but it is still possible to use short courses of other drops if quinolones are either unavailable or contraindicated (e.g. allergy), or when bacteria are resistant to them. However, in such a situation, a round window membrane involved in an established inflammatory process and therefore less permeable to the passage of topical preparations is the preferred setting, as ototoxicity is a potential complication, especially in the case of gentamicin, in which case patients should be warned accordingly.

Over 1% of the adult population in the United Kingdom suffers from active chronic otitis media with a perforated eardrum.[1]

In addition, acute otitis media (AOM) will often end up with a perforated eardrum and a discharging ear. Finally, approximately 10% of patients who undergo ventilation tube insertion for otitis media with effusion will have a discharging ear postoperatively.

All these patients need treatment and long-term follow-up. Antibiotics are usually the first choice for general practitioners and ENT specialists, irrespective of the fact that some cases may need surgical management at some stage.

Besides oral antibiotics, topical ear drops have been a very common method of conservative management. However, concerns about ototoxicity have made many doctors sceptical or even negative towards the wide use of otic preparations. The aim of the present study was to explore the safety of ear drops, to review the existing English literature, and also assess cost-effectiveness and complication rates.

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