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 causing ear discharge and hearing loss.
• Antibiotics are the primary treatment, administered topically or systemically to combat infection.

Purpose of the Study:

• To evaluate the efficacy and safety of topical versus systemic antibiotics for treating CSOM.
• To compare different antibiotic classes and administration routes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases up to June 2022, including Cochrane ENT Register, CENTRAL, MEDLINE, and Embase.
• Included six studies (445 participants) with high risk of bias, comparing topical quinolones with systemic quinolones, aminoglycosides, or penicillin-based antibiotics.

Main Results:

• Topical quinolone administration showed a potential slight increase in ear discharge resolution within one to two weeks (low-certainty evidence).
• Evidence regarding other comparisons, long-term outcomes, quality of life, pain, hearing, and serious complications was very low-certainty or absent.
• Ototoxicity was not suspected in most studies, but assessment methods were unclear.

Conclusions:

• Limited, low- to very low-quality evidence exists, primarily from older studies, hindering definitive conclusions on topical versus systemic antibiotics for CSOM.
• Topical quinolones may offer a slight advantage in achieving a 'dry ear,' but this requires further investigation.
• Insufficient data exists to compare different antibiotic classes or assess adverse effects thoroughly.