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Repurposing Povidone-Iodine for the Treatment of Chronic Suppurative Otitis Media in Nigerian Children
Mercy E Jatto1, Adebolajo A Adeyemo1, Ayotunde J Fasunla1
1University College Hospital.
Insights
Povidone-iodine ear irrigation is as effective as ciprofloxacin drops for treating chronic suppurative otitis media (CSOM) in children. Oral antibiotics showed negligible benefit, suggesting simpler treatments may suffice for uncomplicated CSOM.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Clinical Trials
Background:
- Chronic suppurative otitis media (CSOM) is a common cause of hearing loss in children.
- Antibiotic eardrops are the standard treatment, but rising resistance and treatment failures necessitate alternative therapies.
- Exploring novel treatments is crucial due to increasing antibiotic resistance in CSOM management.
Purpose of the Study:
- To compare the efficacy of povidone-iodine ear irrigation versus ciprofloxacin ear drops for treating uncomplicated CSOM in children.
- To evaluate the added benefit of oral antibiotics in conjunction with topical treatments for CSOM.
- To assess the effectiveness of povidone-iodine irrigation as a standalone treatment for CSOM.
Main Methods:
- An 18-month randomized clinical trial involving 361 children aged 6 months to 14 years with uncomplicated CSOM.
- Three intervention groups: (a) povidone-iodine irrigation + oral amoxicillin-clavulanic acid, (b) ciprofloxacin drops + oral amoxicillin-clavulanic acid, (c) povidone-iodine irrigation alone.
- Treatment duration was 4 weeks, with assessments at 4 weeks and 3 months post-intervention.
Main Results:
- Otorrhea resolution rates were high and comparable across all groups (92.7%-93.7%).
- Tympanic membrane healing rates were 11.7% (group a), 12.7% (group b), and 15.6% (group c).
- Pathologic isolates were absent post-treatment in 75% (group a), 80.3% (group b), and 74.5% (group c) of cases.
Conclusions:
- 0.5% povidone-iodine aural irrigation is non-inferior to 0.3% ciprofloxacin otic suspension for uncomplicated CSOM.
- The addition of oral antibiotics (amoxicillin-clavulanic acid) provided negligible additional benefit in treating uncomplicated CSOM.
- Povidone-iodine ear irrigation represents an effective alternative treatment for uncomplicated CSOM, potentially reducing reliance on oral antibiotics.
Background:
Chronic suppurative otitis media (CSOM) is inflammation of the lining of the middle ear cleft. It is a leading cause of pediatric hearing loss. Antibiotic eardrops are CSOM's mainstay of treatment, but with emerging resistance and increasing treatment failure, the need to explore other treatment options has become pertinent.
Study Design:
This was an 18-month randomized clinical trial of children aged 6 months to 14 years with uncomplicated CSOM, randomized into 3 intervention groups: (a) 0.5% povidone-iodine aural irrigation and oral amoxicillin-clavulanic acid, (b) 0.3% ciprofloxacin aural drops and oral amoxicillin-clavulanic acid, (c) 0.5% povidone-iodine aural irrigation alone. Treatment was for 4 weeks, with postintervention assessments at 4 weeks and 3 months.
Results:
A total of 361 cases completed the study. Otorrhea resolutions were comparable, at 92.7%, 93.7%, and 92.7% for groups a, b, and c, respectively. The proportion of healed tympanic membranes for the groups was 11.7%, 12.7%, and 15.6% for groups a, b, and c. With treatment, the absence of pathologic isolates across groups was 75%, 80.3% and 74.5% for groups a, b and c, respectively.
Conclusion:
This study shows that 0.5% povidone-iodine aural irrigation is at least as effective as 0.3% ciprofloxacin otic suspension in treating uncomplicated CSOM. In addition, any benefit from the use of oral antibiotics in treating uncomplicated CSOM appears to be negligible.
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