Topical versus systemic antibiotics for chronic suppurative otitis media

Area of Science:

• Otolaryngology
• Infectious Diseases
• Pharmacology

Background:

• Chronic suppurative otitis media (CSOM) is a persistent middle ear infection characterized by discharge and hearing loss.
• Antibiotics are the primary treatment, administered topically or systemically to combat polymicrobial infections.

Purpose of the Study:

• To compare the effectiveness of topical versus systemic antibiotic administration for treating CSOM.
• To evaluate outcomes such as ear discharge resolution, quality of life, pain, hearing, and complications.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing topical and systemic antibiotics for CSOM.
• Included studies with at least one-week follow-up and participants with chronic ear discharge.
• Assessed evidence certainty using GRADE methodology.

Main Results:

• Low-certainty evidence suggests topical antibiotics may slightly increase resolution of ear discharge compared to systemic administration (RR 1.48, 95% CI 1.24 to 1.76).
• Limited evidence exists for comparisons between different antibiotic classes, with uncertainty regarding efficacy and adverse effects.
• Most studies had a high risk of bias, and outcomes like quality of life and long-term discharge resolution were often unreported.

Conclusions:

• Topical antibiotic administration shows a potential advantage in achieving a 'dry ear' for CSOM patients, though evidence quality is low.
• Insufficient data prevents definitive conclusions on the comparative efficacy and safety of different topical versus systemic antibiotic types.
• Further high-quality research is needed to clarify optimal antibiotic strategies for CSOM management.