Topical antibiotic ear drops: are they safe?

Abstract

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.

The effect of topical castellani solution on outer hair cell function of rats

“…Use of topical medications in the treatment of ear diseases has many potential advantages over systemic treatment 12. The drugs are applied directly into the site of infection or inflammation, and tissue concentrations are not influenced by absorption, solubility, and elimination that result in higher drug concentrations 13. Such drops also have less potential to develop bacterial resistance than the systemic drugs, have minimal local side effects, such as local irritation, and are mostly free of systemic side effects, such as diarrhea, vomiting, rash, and anaphylaxis 12.…”

Otitis media

“…• Permanent hearing loss independent of otitis media with effusion (OME) • Suspected or confirmed speech and language delays • Autism spectrum disorder and other pervasive developmental disorders • Syndromes (for example, Down syndrome) or craniofacial disorders that include cognitive, speech or language delays • Blindness or uncorrectable visual impairment • Cleft palate, with or without associated syndrome • Developmental delay CSOM Topical quinolone has been shown to be more effective than no drug treatment, topical antiseptics and systemic antibiotics in clearing CSOM-related aural discharge in the short term (<4 weeks) 197,198 . Current evidence assessing the effectiveness of quinolone-containing versus non-quinolone-containing eardrops is inconclusive 198 , with quinolones having the advantage of being non-ototoxic 199 . Limited evidence suggests that treating patients with CSOM with a combination of systemic and topical antibiotics is not more effective than topical antibiotics alone 197 .…”

Bilateral Vestibular Loss

“…Although gentamicin ototoxicity generally occurs in the context of systemic administration, when a tympanic membrane perforation is present, topical ear drops, such as Cortisporin Otic (DSM Pharmaceuticals, Inc., Greenville, NC), which contains neomycin, or Garamycin ophthalmic solution, used off-label can cause ototoxicity by passage through the middle ear and across the round window into the labyrinth. [19][20][21]…”