Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations.
| Title: | Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. |
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| Authors: | Macfadyen CA; Liverpool School of Tropical Medicine, International Health Research Group, Pembroke Place, Liverpool, UK, L3 5QA. carolynm@liv.ac.uk; Acuin JM; Gamble C |
| Source: | The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2006 Jan 25 (1). Cochrane AN: CD005608. Date of Electronic Publication: 2006 Jan 25. |
| Publication Type: | Journal Article; Meta-Analysis; Systematic Review |
| Language: | English |
| Journal Info: | Publisher: Wiley Country of Publication: England NLM ID: 100909747 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-493X (Electronic) Linking ISSN: 13616137 NLM ISO Abbreviation: Cochrane Database Syst Rev Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2004- : Chichester, West Sussex, England : Wiley; Original Publication: Oxford, U.K. ; Vista, CA : Update Software |
| MeSH Terms: | Anti-Bacterial Agents/*administration & dosage ; Otitis Media, Suppurative/*drug therapy ; Tympanic Membrane Perforation/*complications; Administration, Oral ; Administration, Topical ; Chronic Disease ; Humans ; Randomized Controlled Trials as Topic |
| Abstract: | Background: Chronic suppurative otitis media (CSOM) causes ear discharge and impairs hearing.; Objectives: To compare systemic antibiotics and topical antiseptics or antibiotics (excluding steroids) for treating chronically discharging ears with an underlying eardrum perforation (CSOM).; Search Strategy: The Cochrane ENT Disorders Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 1, 2005), MEDLINE (January 1951 to March 2005), EMBASE (January 1974 to March 2005), LILACS (January 1982 to March 2005), AMED (1985 to March 2005), CINAHL (January 1982 to March 2005), OLDMEDLINE (January 1958 to December 1965) PREMEDLINE, Metadatabase of registers of ongoing trials (mRCT), and article references.; Selection Criteria: Randomised controlled trials; any systemic versus topical treatment (excluding steroids); participants with CSOM.; Data Collection and Analysis: One author assessed eligibility and quality, extracted data, entered data into RevMan; two authors provided a second assessment of titles and abstracts, and inputted where there was ambiguity. We contacted investigators for clarifications.; Main Results: Nine trials (833 randomised participants; 842 analysed participants or ears). CSOM definitions and severity varied; some included mastoid cavity infections, other diagnoses, or complications. Methodological quality varied; generally poorly reported, follow-up short, handling of bilateral disease inconsistent. Topical quinolone antibiotics were better than systemic antibiotics at clearing discharge at 1-2 weeks: relative risks (RR) were, 3.21 (95% confidence interval (CI) 1.88 to 5.49) using systemic non-quinolone antibiotics (2 trials, N = 116), and 3.18 (1.87 to 5.43) using systemic quinolone (3 trials, N = 175); or 2.75 (1.38 to 5.46) in favour of systemic plus topical quinolone over systemic quinolone alone (2 trials, N = 90). No statistically significant benefit was seen at 2-4 weeks for topical non-quinolone antibiotic (without steroids) or topical antiseptic over systemic antibiotics (mostly non-quinolones), but numbers were small: one trial tested topical non-quinolones (N = 31); two tested antiseptics (N = 152). No benefit of adding systemic to topical treatment at 1-2 weeks was detected either, although evidence was limited (three trials, N = 204). 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).; Authors' Conclusions: Topical quinolone antibiotics can clear aural discharge better than systemic antibiotics; topical non-quinolone antibiotic (without steroids) or antiseptic results are less clear. Evidence regarding safety was weak. Further studies should clarify topical non-quinolones and antiseptic effectiveness, assess longer-term outcomes (for resolution, healing, hearing, or complications), and include further safety assessments, particularly to clarify the risks of ototoxicity and whether there may be fewer adverse events with topical quinolones than other topical or systemic treatments. |
| Number of References: | 156 |
| Comments: | Comment in: ACP J Club. 2006 Sep-Oct;145(2):48.. (PMID: 16944868); Comment in: Evid Based Med. 2006 Oct;11(5):151. doi: 10.1136/ebm.11.5.151.. (PMID: 17213153) |
| Substance Nomenclature: | 0 (Anti-Bacterial Agents) |
| Entry Date(s): | Date Created: 20060127 Date Completed: 20060407 Latest Revision: 20250623 |
| Update Code: | 20260130 |
| DOI: | 10.1002/14651858.CD005608 |
| PMID: | 16437533 |
| Database: | MEDLINE |
Journal Article; Meta-Analysis; Systematic Review