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Why are ototopical aminoglycosides still first-line therapy for chronic suppurative otitis media? A systematic review and discussion of aminoglycosides versus quinolones

Published online by Cambridge University Press:  20 November 2015

A S Harris ,
H A Elhassan  and
E P Flook
A S Harris*
Affiliation:
Department of Otorhinolaryngology, Betsi Cadwaladr University Health Board, Rhyl, Wales, UK
H A Elhassan
Affiliation:
Department of Otorhinolaryngology, Cardiff and Vale University Health Board, Cardiff, Wales, UK
E P Flook
Affiliation:
Department of Otorhinolaryngology, Betsi Cadwaladr University Health Board, Rhyl, Wales, UK
*
Address for correspondence: Mr Andrew S Harris, 20 Longhouse Barn, Goytre NP4 0AX, Wales, UK E-mail: drewharris@doctors.org.uk
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Abstract

Objective:

This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media.

Method:

The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media.

Results:

Nine trials met the criteria. Two studies showed a higher clinical cure rate in the quinolone group (93 per cent vs 71 per cent, p = 0.04, and 76 per cent vs 52 per cent, p = 0.009). Four studies showed no statistically significant difference in clinical outcome. A significant difference in microbiological clearance in favour of quinolones was shown in two studies (88 per cent vs 30 per cent, p < 0.001, and 88 per cent vs 30 per cent, p < 0.001).

Conclusion:

Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

Keywords

OtologyOtorhinolaryngologyOtitis MediaOtitis Media, SuppurativeOtitis Media, PurulentTympanostomyGrommet InsertionQuinolonesAminoglycosidesCiprofloxacinGentamicinNeomycinFramycetinTobramycinOfloxacinLevofloxacin
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 1 , January 2016 , pp. 2 - 7
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented as a poster at the 15th British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, UK.

References

1Philips, JS, Yung, MW, Burton, MJ, Swan, IR. Evidence review and ENT-UK consensus report for the use of aminoglycoside-containing ear drops in the presence of an open middle ear. Clin Otolaryngol 2007;32:330–6CrossRefGoogle Scholar
2Monasta, L, Ronfani, L, Marchetti, F, Montico, M, Brumatti, LV, Bavcar, A et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS ONE 2012;7:1–12CrossRefGoogle ScholarPubMed
3Ghosh, S, Panarese, A, Parker, AJ, Bull, PD. Quinolone ear drops for chronic otitis media. BMJ 2000;321:126–7CrossRefGoogle ScholarPubMed
4Yorgancılar, E, Yıldırım, M, Gun, R, Bakır, S, Tekın, R, Gocmez, C et al. Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol 2013;270:69–76CrossRefGoogle ScholarPubMed
5Dubey, SP, Larawin, V, Molumi, CP. Intracranial spread of chronic middle ear suppuration. Am J Otol 2010;31:73–7CrossRefGoogle ScholarPubMed
6Macfadyen, CA, Acuin, JM, Gamble, CL. Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev 2005;(4):CD004618CrossRefGoogle ScholarPubMed
7Macfadyen, CA, Acuin, JM, Gamble, CL. Systematic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev 2006;(1):CD005608CrossRefGoogle ScholarPubMed
8Sood, S, Waddell, AJ. Accurate consent for insertion and later removal of grommets. J Laryngol Otol 2007;121:338–40CrossRefGoogle ScholarPubMed
9Syed, MI, Suller, S, Browning, GG, Akeroyd, MA. Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children. Cochrane Database Syst Rev 2013;(4):CD008512CrossRefGoogle ScholarPubMed
10Scottish Intercollegiate Guidelines Network. Antibiotic Prophylaxis in Surgery (SIGN Guideline no. 104). Edinburgh: SIGN, 2008Google Scholar
11Helal, A. Aminoglycoside ear drops and ototoxicity. CMAJ 1997;156:1056–8Google Scholar
12Becvarovski, Z, Bojrab, DI, Michaelides, EM, Kartush, JM, Zappia, JJ, LaRouere, MJ. Round window gentamicin absorption: an in vivo human model. Laryngoscope 2002;112:1610–13CrossRefGoogle ScholarPubMed
13Roland, PS, Rybak, L, Hannley, M, Matz, G, Stewart, MG, Manolidis, S et al. Animal ototoxicity of topical antibiotics and the relevance to clinical treatment of human subjects. Otolaryngol Head Neck Surg 2004;130:S57–78CrossRefGoogle ScholarPubMed
14Bath, AP, Walsh, RM, Bance, ML, Rutka, JA. Ototoxicity of topical gentamicin preparations. Laryngoscope 1999;109:1088–93CrossRefGoogle ScholarPubMed
15Marais, J, Rutka, JA. Ototoxicity and topical eardrops. Clin Otolaryngol Allied Sci 1998;23:360–7CrossRefGoogle ScholarPubMed
16Matz, G, Rybak, L, Roland, PS, Hannley, M, Friedman, R, Manolidis, S et al. Ototoxicity of ototopical antibiotic drops in humans. Otolaryngol Head Neck Surg 2004;130:S79–82CrossRefGoogle ScholarPubMed
17Matthew, R, Asimacopoulos, E, Valentine, V. Toward safer practice in otology: a report on 15 years of clinical negligence claims. Laryngoscope 2011;121:2214–19CrossRefGoogle Scholar
18Medical Protection Society. Problems with eardrops. Casebook 2008. In: http://www.medicalprotection.org/uk/resources/case-reports/case-reports/uk-problems-with-eardrops [20 August 2015]Google Scholar
19Wai, TK, Tong, MC. A benefit-risk assessment of ofloxacin otic solution in ear infection. Drug Saf 2003;26:405–20CrossRefGoogle ScholarPubMed
20Heslop, A, Lildholdt, T, Gammelgaard, N, Ovesen, T. Topical ciprofloxacin is superior to topical saline and systemic antibiotics in the treatment of tympanostomy tube otorrhoea in children: the results of a randomized clinical trial. Laryngoscope 2010;120:2516–20CrossRefGoogle ScholarPubMed
21Dohar, J, Giles, W, Roland, P, Bikhazi, N, Carroll, S, Moe, R et al. Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acid in acute otitis media with otorrhoea through tympanostomy tubes. Pediatrics 2006;118:e561–9CrossRefGoogle ScholarPubMed
22Gates, GA. Safety of ofloxacin otic and other ototopical treatments in animal models and in humans. Pediatr Infect Dis J 2001;20:104–7CrossRefGoogle ScholarPubMed
23Lemke, L, McGee, D, Prieskorn, D, Wall, M, Dolan, D, Altschuler, R et al. Safety of ciprofloxacin and dexamethasone in the guinea pig middle ear. Arch Otolaryngol Head Neck Surg 2009;135:575–80CrossRefGoogle ScholarPubMed
24Kavanagh, K, Parham, K, Schoem, S. Auditory function after a prolonged course of ciprofloxacin-dexamethasone otic suspension in a murine model. Arch Otolaryngol Head Neck Surg 2009;135:238–41CrossRefGoogle ScholarPubMed
25Daniel, SJ, Munguia, R. Ototoxicity of topical ciprofloxacin/dexamethasone otic suspension in a chinchilla animal model. Otolaryngol Head Neck Surg 2008;139:840–5CrossRefGoogle Scholar
26Wall, G, Stroman, D, Roland, P, Dohar, J. Ciprofloxacin 0.3 per cent/dexamethasone 0.1 per cent sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J 2009;28:141–4CrossRefGoogle Scholar
27Clarós, P, Sabater, F, Clarós, A Jr, Clarós, A. Determination of plasma ciprofloxacin levels in children treated with topical ciprofloxacin 0.2% for tympanic perforation [in Spanish]. Acta Otorrinolaringol Esp 2000;51:97–9Google ScholarPubMed
28García-Monge, E, Sabater, F. Study to determine plasma levels of ciprofloxacin after the administration of ciprofloxacin 0.3% ear drops in children with diffuse otitis externa [in Spanish]. Pediatria Rural Y Extrahospitalaria 1997;27:3–8Google Scholar
29Force, RW, Hart, MC, Plummer, SA, Powell, DA, Nahata, MC. Topical ciprofloxacin for otorrhoea after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 1995;121:880–4CrossRefGoogle ScholarPubMed
30Weber, PC, Roland, PS, Hannley, M, Friedman, R, Manolidis, S, Matz, G et al. The development of antibiotic resistant organisms with the use of ototopical medications. Otolaryngol Head Neck Surg 2004;130:S89–94CrossRefGoogle ScholarPubMed
31Blondeau, JM, Suter, ME, Borsos, S, Misfeldt, C. Canadian Pseudomonas aeruginosa susceptibility study from 48 medical centers: focus on ciprofloxacin. Int J Antimicrob Agents 1998;10:297–302CrossRefGoogle ScholarPubMed
32Roland, PS, Stewart, MG, Hannley, M, Friedman, R, Manolidis, S, Matz, G et al. Consensus panel on role of potentially ototoxic antibiotics for topical middle ear use: introduction, methodology, and recommendations. Otolaryngol Head Neck Surg 2004;130(3 suppl):S51–6CrossRefGoogle ScholarPubMed
33Rosser, W, Pennie, R, Pilla, N, Anti-infective Review Panel. Anti-infective Guidelines for Community-Acquired Infections. Toronto: MUMS Guideline Clearinghouse, 2005Google Scholar
34Black, RJ, Cousins, VC, Chapman, P, Becvarovski, Z, Coates, HL, O'Leary, SJ. Ototoxic ear drops with grommet and tympanic membrane perforations: a position statement. Med J Aust 2007;186:605–6CrossRefGoogle ScholarPubMed
35Gilbert, JG, Dawes, PJ, Mahadevan, M, Baber, WJ, Hall, F. Use of ototoxic eardrops: a position statement from the New Zealand Society of Otolaryngology Head and Neck Surgery. N Z Med J 2007;120:U2646Google ScholarPubMed
36Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535CrossRefGoogle ScholarPubMed
37Fradis, M, Brodsky, A, Ben-David, J, Srugo, I, Larboni, J, Podoshin, L. Chronic otitis media treated topically with ciprofloxacin or tobramycin. Arch Otolaryngol Head Neck Surg 1997;123:1057–60Google ScholarPubMed
38Leach, A, Wood, Y, Gadil, E, Stubbs, E, Morris, P. Topical ciprofloxacin versus topical framycetin-gramicidin-dexamethasone in Australian aboriginal children with recently treated chronic suppurative otitis media. Pediatr Infect Dis J 2008;27:692–8CrossRefGoogle ScholarPubMed
39Couzos, S, Lea, T, Mueller, R, Murray, R, Culbong, M. Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double blind randomised controlled trial. Med J Aust 2003;179:185–90CrossRefGoogle ScholarPubMed
40Tong, MC, Woo, JK, Hasselt, CA. A double blind comparative study of ofloxacin otic drops versus neomycin-polymyxin B-hydrocortisone otic drops in the medical treatment of chronic suppurative otitis media. J Laryngol Otol 1996;110:309–14CrossRefGoogle ScholarPubMed
41Miro, N. Controlled multicentre study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000;123:617–23CrossRefGoogle ScholarPubMed
42Nawasreh, O, Fraihat, A. Topical ciprofloxacin versus topical gentamicin for chronic otitis media. East Mediterr Health J 2001;7:26–30CrossRefGoogle ScholarPubMed
43Tutkun, A, Ozagar, A, Koc, A, Batman, C, Uneri, C, Sehitglu, MA. Treatment of chronic ear disease. Topical ciprofloxacin vs topical gentamicin. Arch Otolaryngol Head Neck Surg 1995;121:1414–16CrossRefGoogle ScholarPubMed
44Morpeth, JF, Bent, JP, Watson, T. A comparison of cortisporin and ciprofloxacin otic drops as prophylaxis against post-tympanostomy otorrhoea. Int J Pediatr Otorhinolaryngol 2001;61:99–104CrossRefGoogle Scholar
45Poetker, DM, Lindstrom, DR, Patel, NJ, Conley, SF, Planary, VA, Link, TR et al. Ofloxacin otic drops vs neomycin-polymixin B otic drops as prophylaxis against early postoperative tympanostomy tube otorrhea. Arch Otolaryngol Head Neck Surg 2006;132:1294–8CrossRefGoogle Scholar
46Poole, MD. Bacterial resistance to quinolone otic drops is nearly zero. Ear Nose Throat J 2007;86:13–14CrossRefGoogle Scholar
47Joint Formulary Committee. British National Formulary (BNF) 68. London: BMJ/Pharmaceutical Press, 2014Google Scholar
48General Medical Council. Prescribing guidance: Prescribing unlicensed medicines. In: http://www.gmc-uk.org/guidance/ethical_guidance/14327.asp [20 August 2015]Google Scholar
49Medicines and Healthcare Products Regulatory Agency. Apply for a licence to market a medicine in the UK. In: http://www.mhra.gov.uk/Howweregulate/Medicines/Licensingofmedicines/index.htm [20 August 2015]Google Scholar
50Therapeutic Goods Administration. CILOQUIN® (ciprofloxacin) 0.3 per cent Ear Drops. Australia 2013. In: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-02436-3 [20 August 2015]Google Scholar
51Therapeutic Goods Administration. CILOXAN® (ciprofloxacin) 0.3 per cent Ear Drops. Australia 2014. In: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-02301-3 [20 August 2015]Google Scholar
52Alcon Canada. Product Monograph: Ciprodex. Health Canada 2004. In: http://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng [31 August 2015]Google Scholar
53US Food and Drug Administration. FDA approved drug products. Search: Ciprofloxacin. In: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm [10 March 2015]Google Scholar