Ototopical neomycin exposure in children with nonintact tympanic membranes

Although contraindicated, neomycin otic preparations may be administered to children with nonintact tympanic membranes (TMs), such as tympanostomy tubes or TM perforations. The goal of this study was to assess the magnitude of neomycin exposure in children with nonintact TMs.

Retrospective drug utilization study.

Medicaid claims data (years 1999-2006) from 28 states for children aged 0 to 18 years were analyzed to identify new cases of tube placement or TM perforation. Cases were followed for 12 months to determine neomycin otic utilization.

Of the 300,470 children with nonintact TMs, neomycin otic preparations were prescribed in 43,815 (15%). Nontoxic agents (ofloxacin or ciprofloxacin) were used in 48%. In 19%, neomycin preparations were prescribed at the day of initial nonintact TM diagnosis, 52% and 71% within the first 3 or 6 months, respectively. Neomycin otic utilization decreased from 27% in cases diagnosed in 1999 to 7% in 2005 (P < .0001).

Many children with nonintact TMs receive exposure to agents with potential ototoxicity, despite the availability of safer alternatives. Further study is necessary to determine why neomycin otic preparations continue to be prescribed in the presence of nonintact TMs and if such exposure is associated with ototoxicity.