Topical ciprofloxacin is superior to topical saline and systemic antibiotics in the treatment of tympanostomy tube otorrhea in children: The results of a randomized clinical trial

Abstract

The significant effect of topical ciprofloxacin is probably related to a higher local concentration of antibiotics in the middle ear rather than the result of mechanical rinsing and dissolution of the bacterial load.

Topical versus oral antibiotics, with or without corticosteroids, in the treatment of tympanostomy tube otorrhea

“…First, the mechanical removal or dilution of bacterial load may augment the efficacy of local antimicrobial activity for topical ear drops. This was seen in the study by Heslop et al [13] where mechanical saline rinsing had a lower failure rate as compared to oral amoxicillin (58% vs 70%) [13]. Second, the drug concentration achieved in the middle ear mucosa will be higher with topical antibiotics as compared to oral antibiotics.…”

“…Of these, only 4 [11][12][13][14] fulfilled the inclusion criteria. These 4 studies were published between years 1998 and 2014.…”

“…Our meta-analysis revealed a higher incidence of diarrhea and dermatitis in patients who took oral antibiotics. Side-effects affect compliance, and while no formal analysis was conducted, previous study authors have suspected a higher compliance rate in patients who received local rather than oral therapy [13]. Furthermore, topical antibiotics have not been shown to induce microbiological resistance [8], which is a worry in widespread usage of systemic antibiotics.…”

“…In adults with chronic suppurative otitis media, topical antibiotics are more efficacious in reducing otorrhea than either oral [16] or intramuscular [17]antibiotics, possibly because the tympanic membrane perforation permits a higher local drug concentration to be achieved with topical antibiotic therapy. For pediatric patients with tube otorrhea, studies have shown failure rates of between 10% and 23% with ciprofloxacin-containing ear drops versus 20%-70% with oral antibiotics alone [12,13,[18][19][20].…”

“…Sub-group analysis showed that the addition of steroids to topical solutions was associated with a higher and statistically significant cure rate as compared to those who used topical antibiotic ear drops without steroids. Van Dongen et al reported a 5% treatment failure rate with antibiotic-steroid ear drops [14], while Heslop et al [13] and Goldblatt et al [11] reported a 23% and 24% treatment failure rate respectively with antibiotic-only ear drops. Experimental animal studies showed otorrhea in a primate model of chronic suppurative otitis media resolved more quickly when steroids was given as part of the therapy [26].…”