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Updated: Sep 5, 2025

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Systemic antibiotics for chronic suppurative otitis media.

Lee-Yee Chong1, Karen Head2, Katie E Webster2

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Systemic antibiotics show uncertain benefits for chronic suppurative otitis media (CSOM) ear discharge. Evidence is limited, with little to no difference when added to topical treatments, and adverse effects are poorly reported.

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Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Pharmacology

Background:

  • Chronic suppurative otitis media (CSOM) is a persistent middle ear infection causing discharge and hearing loss.
  • Systemic antibiotics are a common treatment for CSOM, targeting causative microorganisms.

Purpose of the Study:

  • To evaluate the effectiveness of systemic antibiotics in treating chronic suppurative otitis media (CSOM).

Main Methods:

  • Systematic review and meta-analysis of 18 randomized controlled trials (RCTs) involving 2135 participants.
  • Included trials compared systemic antibiotics (oral or intravenous) against placebo/no treatment or other systemic antibiotics.
  • Outcomes assessed included resolution of ear discharge, health-related quality of life, ear pain, hearing, and complications.

Main Results:

  • Evidence is very uncertain regarding the efficacy of systemic antibiotics alone compared to placebo for ear discharge resolution.
  • When systemic antibiotics were added to topical treatments, there was little to no difference in discharge resolution (low-certainty evidence).
  • Limited data prevented conclusions on the comparative effectiveness of different antibiotic classes, and adverse events were poorly reported.

Conclusions:

  • The evidence for the efficacy of systemic antibiotics in CSOM is limited and of very low to low certainty.
  • Systemic antibiotics may offer little to no additional benefit when used with topical treatments for CSOM.
  • Poor reporting of adverse effects necessitates caution regarding the use of systemic antibiotics for CSOM.