Quinolone antibiotic eardrops best for treating middle ear infections

Topical quinolone antibiotics can clear aural discharge better than systemic antibiotics. This was the finding of a systematic review of literature published in the latest update of The Cochrane Library.

Chronically discharging ears associated with underlying persistent eardrum perforations (chronic suppurative otits media (CSOM)) are a common cause of preventable hearing impairment, particularly in low and middle income countries.

The disease usually occurs in the first five years of life, but may persist to adulthood. Untreated CSOM may cause permanent hearing loss as the small sound-transmitting bones in the middle ear become damaged. When it occurs in children, the reduction in hearing can also impair language development and the acquisition of speech.

A systematic review of literature found that short courses of topically administered quinolone antibiotic drops such as ciprofloxacin were more effective at drying the ear than oral or injected antibiotics. The Review Authors were unable to find enough high quality data to assess the value of topical non-quinolone antibiotics that do not contain steroids, or of antiseptic treatments, when compared to systemic treatments.

"Less is known about the longer-term outcomes, or about treating complicated CSOM," says lead author Carolyn Macfadyen a Research Associate at the International Health Research Group in the Liverpool School of Tropical Medicine, UK.

The Review Authors also noted that the evidence regarding safety of topical antibiotics is weak, and believe that clinicians should watch for any signs of ototoxicity when using topical treatment, particularly for non-quionlones such as aminoglycoside.

"The cost effectiveness of alternative treatments, preferably through economic evaluations alongside clinical trials, would be valuable in guiding both clinical practice and health policy," says Macfadyen.