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Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a
Sophie Couzos1, Traven Lea, Reinhold Mueller
1National Aboriginal Community Controlled Health Organisation, PO Box 168, Deakin, ACT 2600, Australia. scouzos@tpgi.com.au
Insights
Topical ciprofloxacin ear drops effectively treated chronic suppurative otitis media in Aboriginal children. This treatment showed higher cure rates compared to other eardrops, making it a recommended first-line option.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pediatrics
Background:
- Chronic suppurative otitis media (CSOM) is a significant health issue in Aboriginal children.
- Effective community-level treatments are crucial for managing CSOM in this population.
Purpose of the Study:
- To compare the efficacy of topical ciprofloxacin (CIP) versus a combination of framycetin, gramicidin, and dexamethasone (FGD) eardrops for treating CSOM in Aboriginal children.
- To evaluate the impact of these treatments on clinical cure, tympanic membrane healing, and hearing improvement.
Main Methods:
- A multicentre, double-blind, randomised controlled trial was conducted in eight Aboriginal Community Controlled Health Services.
- 147 Aboriginal children diagnosed with CSOM participated, receiving either CIP or FGD eardrops with povidone-iodine ear cleaning.
- Outcomes were assessed 10-21 days post-treatment, focusing on otorrhoea resolution, tympanic membrane perforation healing, and hearing changes.
Main Results:
- A clinical cure rate of 64% was observed, with significantly higher efficacy in the ciprofloxacin group (76.4%) compared to the FGD group (51.8%) (P = 0.009).
- No significant changes were noted in tympanic membrane perforation size or hearing impairment levels between the groups.
- Pseudomonas aeruginosa was the predominant pathogen (47.6%), while respiratory pathogens were infrequent (5.7%).
Conclusions:
- Twice-daily ear cleaning combined with topical ciprofloxacin is an effective community-level treatment for achieving CSOM cure in Aboriginal children.
- Healthcare providers should consider topical ciprofloxacin as a preferred first-line treatment for CSOM in this demographic.
Objectives:
To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children.
Design And Participants:
Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM.
Main Outcome Measures:
Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10-21 days after starting treatment.
Results:
111 children aged 1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%).
Conclusions:
Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.
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