Topical Quinolone Antibiotics Outperform Systemics for Otitis Media

January 30, 2006

Topical Quinolone Antibiotics Outperform Systemics for Otitis Media

Topical quinolone antibiotics, such as Cipro (ciprofloxacin), treat ear infections with discharge more effectively than systemic antibiotics, according to a new report.

In a systematic review of randomized, controlled trials that compared use of topical antibiotics with systemic agents for chronic suppurative otitis media, topical quinolone antibiotics such as Cipro cleared aural discharge better than systemic antibiotic drugs.

Chronic suppurative ear infections can cause significant hearing loss.

The study was conducted by Carolyn MacFayden and colleagues of the International Health Research group at the Liverpool School of Tropical Medicine and reported in the online Cochrane Database of Systematic Reviews.

"Chronically discharging ears associated with underlying persistent eardrum perforations are a common cause of preventable hearing impairment worldwide, particularly in low and middle-income countries," MacFayden and colleagues wrote, reported MedPage Today.

"Chronic suppurative otitis media usually occurs in the first five years of life (although it often persists into adulthood), and is related to poor socioeconomic conditions."

Chronic suppurative otitis media is "a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane (i.e. perforated eardrum) and discharge otorrhea, for at least the preceding two weeks," according to the World Health Organization.

Data Analysis

The reviewers included in their analysis randomized, controlled trials comparing treatment of chronic suppurative otitis media with systemic therapy versus any topical treatment except steroids. Their goal was to determine the best treatment for chronically discharging ears with an underlying eardrum perforation.

Eight trials met the researchers' search criteria, although they noted that the definition and severity of chronic suppurative ear infections differed between the studies, and most of the studies reported less than two weeks of follow-up.

The data showed that, at 1-2 weeks, topical quinolones outperformed systemic antibiotics (both quinolone and non-quinolone agents) at clearing and drying the ears. Moreover, at 1-2 weeks, adding systemic drugs to topical agents offered no advantage, although evidence for this observation was limited.

Topical quinolones had a significant advantage over systemic non-quinolone agents and systemic quinolones. Also, combined topical and systemic quinolone (ciprofloxacin) were more effective than systemic quinolone alone.

"No statistically significant benefit was seen at two to four weeks for topical non-quinolone antibiotic (without steroids) or topical antiseptic over systemic antibiotics (mostly non-quinolones), but numbers were small," the authors noted, reported MedPage Today.

"Evidence regarding safety was generally weak. Adverse events reported were generally mild, although hearing worsened by ototoxicity (damaging auditory hair cells) was seen with chloramphenicol drops (non-quinolone antibiotic)," the researchers wrote.

Sources:
Topical Antibiotics Beat Systemics for Clearing Suppurative Otitis Media, MedPage Today, January 25, 2006.
Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Macfadyen CA, Acuin JM, Gamble C, The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005608. DOI: 10.1002/14651858.CD005608.

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