Related Experiment Videos
[Choice of ear drops in chronic otorrhea]
E A Mylanus1, S Natsch, J J Mulder
1Afd. Keel-, Neus- en Oorheelkunde, Universitair Medisch Centrum St. Radboud, HB Nijmegen. e.mylanus@kno.azn.nl
Abstract:
In chronic otitis, the use of ear drops has certain advantages over the use of systemic antibiotics. The choice of ear drop depends on the condition of the eardrum, microbial pathogens present and the efficacy of the components of the ear drop. Ototoxicity, contact allergy and the development of bacterial resistance have to be taken into account. Ototoxicity is a rare complication of the application of ear drops, most often described when aminoglycosides were applied. Contact allergy is also most often seen in aminoglycoside-containing eardrops. Evaluation of ear swabs demonstrated a 5% resistance of Pseudomonas aeruginosa to ciprofloxacin. The appearance of resistant strains may impede systemic use of fluoroquinolones. Therefore, this class of antibiotics should be considered as reserve medication only. The first choice in local application of antiseptics in case of an open eardrum is aluminium acetotartrate 1.2% and, of a combination preparation, bacitracin-colistin-hydrocortisone. In case of a closed eardrum (external otitis) aluminium acetotartrate 12%--combination preparations with corticosteroids are advised against in these cases.
Insights
Ear drops offer advantages for chronic otitis treatment over systemic antibiotics. Careful selection considers eardrum status, pathogens, and potential resistance, with specific recommendations for open versus closed eardrums.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pharmacology
Context:
- Chronic otitis management requires careful antibiotic selection.
- Ear drops present distinct advantages over systemic antibiotics for otitis treatment.
- Factors influencing ear drop choice include eardrum integrity, causative pathogens, and component efficacy.
Purpose:
- To review the advantages and considerations for using ear drops in chronic otitis.
- To highlight potential complications such as ototoxicity, contact allergy, and bacterial resistance.
- To provide guidance on appropriate ear drop selection based on clinical scenarios.
Summary:
- Ototoxicity and contact allergy are rare but noted complications, particularly with aminoglycosides.
- Pseudomonas aeruginosa exhibits 5% resistance to ciprofloxacin, suggesting fluoroquinolones be reserved.
- Recommended first-line treatments include aluminium acetotartrate 1.2% for open eardrums and bacitracin-colistin-hydrocortisone combination preparations.
Impact:
- Informed ear drop selection can optimize treatment outcomes for chronic otitis.
- Awareness of resistance patterns aids in preserving antibiotic efficacy.
- Guidelines for specific ear conditions, like external otitis with closed eardrums, prevent inappropriate corticosteroid use.