Cochrane review of topical antibiotics for chronic suppurative otitis media

  • Brennan-Jones CG & al.
  • Cochrane Database Syst Rev
  • 2 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • There is a lot of uncertainty on the efficacy of topical antibiotics (without steroids) in improving resolution of ear discharge in patients with chronic suppurative otitis media (CSOM).
  • Addition of systemic antibiotic to topical antibiotics (without steroids) may be effective in improving resolution of ear discharge in patients with CSOM compared with placebo.
  • Evidence regarding the efficacy of different types of antibiotics and to determine whether quinolones are better or worse than aminoglycosides is uncertain.

Why this matters

  • Topical antibiotics can be used alone or in combination with other treatments, such as antiseptics or ear cleaning (aural toileting), for the treatment of CSOM.

Study design

  • Cochrane review of 17 randomised controlled trials (n=2198) after a search across Cochrane database, Ovid MEDLINE, and others.
  • Funding: None disclosed.

Key results

  • Ciprofloxacin was better than placebo (risk ratio [RR], 6.74; 95% CI, 1.82-24.99; very low-certainty evidence) and no treatment (RR, 1.47; 95% CI, 1.20-1.80; low-certainty evidence) in improving resolution of ear discharge at 1-2 weeks.
  • Ciprofloxacin had a higher resolution of ear discharge at 1-2 weeks compared with topical aminoglycosides (gentamicin, neomycin or tobramycin) (RR, 1.95; 95% CI, 0.88-4.29; very low-certainty evidence; I2=97%).
  • Ciprofloxacin was better than neomycin/polymyxin B/gramicidin combination in improving resolution of ear discharge (RR, 1.12; 95% CI, 1.03-1.22).
  • Uncertain evidence was observed regarding the efficacy of different types of topical antibiotics for all outcomes.

Limitations

  • Risk of bias.