Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Venekamp, Roderick P; Prasad, Vibhore

doi:10.1136/bmj.i308

Cited by 17 publications

(8 citation statements)

References 11 publications

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“…Current approaches that need further work include topical antibiotics for AOM with ear discharge due to a spontaneous tympanic membrane perforation. The topical antibiotic approach has proven very effective in children with ventilation tubes 193 , but it is uncertain if these results are also applicable to children without tubes 235 .…”

Section: Treatmentmentioning

confidence: 99%

Otitis media

Schilder

Chonmaitree

Cripps

et al. 2016

Nat Rev Dis Primers

389

361

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Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

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Section: Treatmentmentioning

confidence: 99%

Otitis media

Schilder

Chonmaitree

Cripps

et al. 2016

Nat Rev Dis Primers

389

361

View full text Add to dashboard Cite

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“…A landmark trial in the Netherlands in such children showed higher resolution rates of ear discharge at 2 weeks compared with oral antibiotics and initial observation (absolute resolution rates, 72 of 76 children [95%] for topical antibiotics versus 43 of 77 children [56%] for oral antibiotics versus 34 of 75 children [45%] for initial observation) 44. Various topical antibiotic formulations are available in the UK, of which the non-ototoxic quinolone containing drops are currently considered most appropriate 45…”

Section: How Is It Managed?mentioning

confidence: 99%

“…These children tend to have a worse prognosis and a more prolonged duration of ear pain and/or fever than those without ear discharge 2122. Topical antibiotics might be an attractive alternative to oral antibiotics in these children, because they are considered to cause less antimicrobial resistance,46 but to date no evidence supports the use of locally applied antibiotics in these children 45…”

Section: How Is It Managed?mentioning

confidence: 99%

Acute middle ear infection (acute otitis media) in children

Venekamp

Schilder

Heuvel³

2020

BMJ

Self Cite

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“…A recent review found "no strong direct evidence to support the use of topical antibiotics in children with acute otitis media and ear discharge caused by spontaneous perforation of the eardrum," 15 supporting current advice that antibiotics should be prescribed orally for otitis media in young children and when signs and symptoms are severe. 12 A combination of an antibiotic and a corticosteroid is recommended as second-line therapy in the treatment of acute otitis externa, for which bacterial resistance does not appear to be an active concern.…”

Section: Ear Infectionsmentioning

confidence: 99%