Available data, though limited, suggest topical quinolone antibiotics are better than systemic antibiotics for treating chronic suppurative otitis media, according to a new Cochrane review of systemic antibiotic and topical treatments for the condition.
For the review, Dr. Carolyn A. Macfadyen of the Liverpool School of Tropical Medicine (England), and her colleagues searched the literature and identified nine relevant randomized controlled trials, including four that enrolled children under age 16 years. The trials involved a total of 833 randomized participants and 842 analyzed participants or ears.
Findings from the studies, which had short follow-up and were regarded by the authors as poorly reported, suggest that quinolone antibiotic drops such as ciprofloxacin had better ear-drying effects than either systemic quinolone antibiotics (relative risk 3.18) or systemic nonquinolone antibiotics (relative risk 3.21) at 1–2 weeks after the start of treatment. This finding was based on pooled data from two trials involving 116 patients with chronic suppurative otitis media (CSOM).
Systemic antibiotics plus topical quinolones were superior to systemic quinolones alone (relative risk 2.75), according to pooled data from two trials involving 90 CSOM patients.
Limited evidence from one trial with 31 patients suggested there was no significant benefit for topical nonquinolones or antiseptics, compared with systemic antibiotics at 2–4 weeks, and limited evidence based on three trials with 204 participants suggested there was no benefit to adding systemic treatment to topical treatment at 1–2 weeks, the investigators reported (The Cochrane Database of Syst. Rev. 2006;DOI:10.1002/14651858.CD005608).
Good evidence regarding long-term outcomes—such as ear-drying, complication prevention, healing of eardrum perforations, and hearing improvement—was lacking, as were data defining the role of topical nonquinolones and antiseptics, data on treating complicated CSOM, and data on safety. These matters should be addressed in future studies, the authors recommended. The lack of safety data and information on the risk of ototoxicity with alternative treatments, which is of particular concern, warrants regular medical follow-up, clinical vigilance, and monitoring for adverse treatment effects and disease complications in patients being treated for CSOM, they said.