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Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

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Systemic antibiotics for chronic suppurative otitis media.

Lee Yee Chong¹, Karen Head¹, Katie E Webster²

¹Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

The Cochrane Database of Systematic Reviews

|June 8, 2025

Summary

This summary is machine-generated.

Systemic antibiotics show very uncertain effectiveness for chronic suppurative otitis media (CSOM) ear discharge resolution. Evidence suggests little to no difference when added to topical treatments, with limited data on harms.

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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.
Systemic antibiotics are a common treatment, but their efficacy in CSOM requires rigorous evaluation.
This review is an update, part of a series assessing non-surgical interventions for CSOM.

Purpose of the Study:

To evaluate the effectiveness of systemic antibiotics versus placebo, no treatment, or other systemic antibiotics for CSOM.
To assess outcomes including ear discharge resolution, quality of life, pain, hearing, and complications.

Main Methods:

A systematic review of randomized controlled trials (RCTs) was conducted, searching multiple databases up to June 2022.
Included RCTs compared systemic antibiotics (oral/injection) to placebo/no treatment or other systemic antibiotics in patients with CSOM.
Primary outcomes were resolution of ear discharge, health-related quality of life, and ear pain; secondary outcomes included hearing and complications.

Main Results:

Evidence is very uncertain regarding the effectiveness of systemic antibiotics alone versus placebo for ear discharge resolution.
When systemic antibiotics are added to topical treatments, there may be little to no difference in discharge resolution (low-certainty evidence).
Data on quality of life, hearing, complications, and harms were limited or very uncertain across comparisons.

Conclusions:

The available evidence for systemic antibiotic efficacy in resolving CSOM ear discharge is limited and uncertain.
Systemic antibiotics, alone or as adjuncts to topical therapy, show minimal to no clear benefit for discharge resolution.
Further research is needed, particularly on the comparative effectiveness of different antibiotic classes and potential harms.