Related Experiment Video
Updated: Aug 25, 2026
Quadruple-Checkerboard: A Modification of the Three-Dimensional Checkerboard for Studying Drug Combinations
Published on: July 24, 2021
The development of antibiotic resistant organisms with the use of ototopical medications
Peter C Weber1, Peter S Roland, Maureen Hannley
1Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Objective:
There is growing concern over the use of systemic antibiotics and the development of bacterial resistance. The question remains as to whether ototopical medications may also promote antibiotic-resistant organisms, either on a local level (in the ear) or in other areas of the aerodigestive tract. We performed an evidence-based review to answer the following clinical question, "Do antibiotic ototopical medications induce antibiotic resistant organisms?"
Study Design:
We performed a MEDLINE search of the published literature from 1966 to the present. We used appropriate search terms such as "ototopical antibiotics," "ototopical drops," "antibiotic resistance," "topical antibiotics and otitis externa," "otitis externa and treatment," "otitis externa and antibiotic drops," "otitis externa and ototopical drops," "otitis media," "otitis media and treatment," "otitis media and antibiotic drops," "chronic suppurative otitis media," "chronic suppurative otitis media and treatment," "chronic suppurative otitis media and antibiotic drops," " otitis externa and resistant organisms," "otitis media and resistant organisms," "chronic suppurative otitis media and resistant organisms," "ophthalmic antibiotic drops," "draining ear," "P.E. tube otorrhea," "pressure equalizing tube otorrhea," "pressure equalizing tube otorrhea and treatment," and "pressure equalizing tube otorrhea and ototopical therapy" to identify pertinent articles. These articles were reviewed and graded according to the evidence quality.
Results:
After an initial screening of over 2,500 articles, 38 articles were analyzed further; of these, 11 were determined to warrant extensive review. Eight articles evaluated chronic suppurative otitis media; 2, otitis externa; and 1, post-tympanostomy tube otorrhea, whereas 3 others studied systemic absorption. Of the 8 chronic suppurative otitis media studies, there were thought to be 5 grade 2B studies, 1 grade 1B study, and 1 grade 2C study. These studies did not demonstrate a propensity for the development of resistant organisms. No study answered the question as to whether resistance to systemic antibiotics might occur in otitis externa.
Conclusions:
Overall grade B evidence seems to indicate that no significant antibiotic resistance develops from the use of ototopical antibiotic treatment.
Insights
Topical antibiotic ear drops do not appear to cause antibiotic resistance. This review found no significant evidence of resistant organisms developing from ototopical antibiotic treatments for ear infections.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pharmacology
Background:
- Growing concerns exist regarding antibiotic resistance from systemic antibiotic use.
- The potential for ototopical (ear drop) antibiotic medications to induce antibiotic resistance locally or systemically remains unclear.
Purpose of the Study:
- To conduct an evidence-based review to determine if antibiotic ototopical medications induce antibiotic-resistant organisms.
- To answer the clinical question: "Do antibiotic ototopical medications induce antibiotic resistant organisms?"
Main Methods:
- A comprehensive MEDLINE search of the literature from 1966 to the present was performed.
- Keywords included various terms related to ototopical antibiotics, antibiotic resistance, and specific ear conditions like otitis externa, otitis media, and chronic suppurative otitis media.
- Articles were reviewed and graded based on the quality of evidence.
Main Results:
- Out of over 2,500 initially screened articles, 11 were extensively reviewed.
- Studies focused on chronic suppurative otitis media (8 articles), otitis externa (2 articles), and post-tympanostomy tube otorrhea (1 article).
- The majority of studies (8 on chronic suppurative otitis media) did not demonstrate a propensity for the development of resistant organisms. No study specifically addressed resistance in otitis externa.
Conclusions:
- Available evidence (Grade B) suggests that ototopical antibiotic treatments do not lead to significant antibiotic resistance.
- Further research may be needed to fully understand potential resistance patterns in conditions like otitis externa.
Related Concept Videos
01:30Development of Antibiotic Resistance
01:25Mechanism of Antibiotic Resistance in MRSA
00:57Antibiotic Selection
01:25Clinical Significance of Antibiotic Resistance
01:21Microbiota Modulation by Antibiotics
01:31Defense Against Bacterial Pathogens
Phagocytes
Phagocytes are the frontline soldiers of the immune system. They include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cell and are quickly mobilized to the site of infection. Macrophages are larger cells that patrol...