Topical antibiotic ototoxicity: does it influence our practice?

Area of Science:

• Otolaryngology
• General Practice
• Pharmacology

Background:

• Discharging ears are common conditions managed by both general practitioners (GPs) and Ear, Nose, and Throat (ENT) specialists.
• Existing management strategies may vary between primary care and specialist settings.
• Investigating these differences is crucial for optimizing patient care.

Purpose of the Study:

• To compare the management approaches for discharging ears between GPs and ENT specialists.
• To identify specific differences in the use of topical antibiotics.
• To assess the potential impact of a novel non-ototoxic topical antibiotic on treatment preferences.

Main Methods:

• A postal questionnaire survey was conducted.
• Participants included all GPs in the Birmingham area and UK-based ENT consultants.
• The survey focused on current practices and future treatment considerations for discharging ears.

Main Results:

• For intact tympanic membranes, 99% of consultants and 90% of GPs favored topical antibiotics.
• For perforated tympanic membranes, 97% of consultants used topical antibiotics versus only 43% of GPs, citing ototoxicity concerns.
• A significant majority of both groups (93% consultants, 88% GPs) would consider a non-ototoxic topical antibiotic as first-line treatment.

Conclusions:

• Significant divergence exists in the management of discharging ears, particularly regarding topical antibiotic use with perforated tympanic membranes.
• Fear of ototoxicity influences GPs' reluctance to use topical antibiotics in certain cases.
• The introduction of an effective, non-ototoxic topical antibiotic could significantly alter current treatment paradigms for ear infections.