Topical antibiotics for chronic suppurative otitis media

Area of Science:

• Otolaryngology
• Infectious Diseases
• Pharmacology

Background:

• Chronic suppurative otitis media (CSOM) is a persistent middle ear inflammation and infection characterized by ear discharge and hearing loss.
• Topical antibiotics are a common treatment, aiming to eliminate causative microorganisms.
• This review focuses on topical antibiotic efficacy without steroids for CSOM management.

Purpose of the Study:

• To evaluate the effectiveness of topical antibiotics, excluding steroids, for treating chronic suppurative otitis media (CSOM).
• To compare topical antibiotics against placebo or no intervention.
• To compare different classes of topical antibiotics against each other.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted, searching multiple databases up to April 2019.
• Included participants had chronic ear discharge for over two weeks; interventions involved topical antibiotics as drops, powders, or irrigations.
• Primary outcomes included resolution of ear discharge, quality of life, and ear pain; secondary outcomes covered hearing and complications.

Main Results:

• Limited evidence from 17 RCTs (2198 participants) suggests topical antibiotics may be more effective than placebo for discharge resolution (low to very low certainty).
• When used with systemic antibiotics, topical ciprofloxacin showed better discharge resolution than no topical treatment (low certainty).
• Comparisons between different topical antibiotic classes (quinolones vs. aminoglycosides) yielded very low certainty evidence, making definitive conclusions impossible.

Conclusions:

• The effectiveness of topical antibiotics for CSOM is uncertain due to limited, low-quality evidence.
• Some evidence suggests topical antibiotics may be beneficial compared to placebo or when used adjunctively with systemic antibiotics.
• The relative efficacy and safety of different topical antibiotic agents remain unclear, with poorly reported adverse effects.