Systemic antibiotics for chronic suppurative otitis media

Background: Prior to surgical management of chronic suppurative otitis media (CSOM) for the dry ear medical management is necessary. CSOM is a biofilm disease and due to this has antibiotic resistance. The pillar of its treatment included aural cleaning according to standard protocols, application of topical germ free antiseptic and use of antimicrobials. Acetic acid due to its ability in reducing the pH may be effective in reducing the growth of microorganisms. Objective: The aim of the study was to compare the efficacy of irrigation with acetic acid versus systemic antibiotics in CSOM patients. Materials & Methods: A total of 134 patients, who came to the ENT department of Sheikh Zayed Hospital, Lahore between 1st April 2020 to 30th September 2020, who had CSOM, of age 15 to 55 years and both genders were included in the study. The patients were divided randomly into two groups. Group A patients received aural toilets and irrigation with acetic acid and Group B received 500 mg of ciprofloxacin twice a day for 2 weeks. Results: The mean age (in years) of the patients in Group A was 37.45±7.32 and in Group B, it was 37.96±7.57. The efficacy of irrigation with acetic acid versus systemic antibiotics was 89.55% and 68.66% respectively and this difference between the two groups was found to be statistically significant (p=0.003). Conclusion: Irrigation with acetic acid was better than systemic antibiotics in managing patients with CSOM. Key words: Acetic acid, CSOM, Middle ear

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Treatment of Chronic Suppurative Otitis Media: A Comparison between Topical, Systemic and Combined Topical-Systemic antibiotics

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v4i1.52871 ◽

2015 ◽

Vol 4 (1) ◽

pp. 27-32

Author(s):

Syed Hasan Imam Al Masum ◽

Ali Jacob Arsalan

Keyword(s):

Hearing Impairment ◽

Otitis Media ◽

Hearing Threshold ◽

Chronic Suppurative Otitis Media ◽

Treatment Modalities ◽

Suppurative Otitis Media ◽

Duration Of Illness ◽

Significant Difference ◽

Successful Resolution ◽

Systemic Antibiotics

Background and Objectives: The present study was undertaken to determine which of the three treatment modalities (topical, systemic and topical systemic combined) is the best in treating chronic suppurative otitis media (CSOM) in children. Patients & Methods: This comparative clinical trial was conducted prospectively in Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka over a period of 6 months. We enrolled 92 children with chronic CSOM, aged 5- 12 years, from patients attending at pediatric ENT OPD. The children were randomly assigned to three treatment groups. All parents were advised dry mopping of their children two times daily. The first group (n = 51) received topical ciprofloxacin 4 times daily, the second group received systemic ciprofloxacin only10 mg/kg body weight/day twice daily for 14 days and the third group received both systemic and topical ciprofloxacin. The primary outcome measures were resolution of otorrhoea by 2 - 3 weeks of intervention and healing of tympanic membranes on otoscopy by 8-12weeks of intervention. Hearing levels were assessed by audiometry. Results: Of the three groups of children enrolled in the study, the topical-systemic group was significantly older than the topical and systemic groups (p = 0.003). However, the groups were not different in terms of sex and duration of illness (p = 0.125 and p = 0.191 respectively). The cardinal presentation was otorrhoea. Over half of the children in each group had marginal perforation (p=0.062). Most of the children in each group had mild hearing impairment (p = 0.212). Poor attention and poor academic performance were rarely found. After 2 weeks of treatment, majority of patients in Topical, Systemic and Topical Systemic Combined Group had a successful resolution (92.1%, 95.4% and 94.7%) with no significant difference among the groups (p = 0.641). Time taken for resolution was almost similar among the groups with mean resolution time being 2 weeks (p = 0.313). Difference among the groups regarding hearing impairment was evident with highest impairment being in the Topical and the lowest in the combined group (p = 0.048). Among groups, topical and systemic group had higher improvement of hearing threshold than topical, systemic combined group (p=0.024). The groups were no different with respect to treatment failure (p = 0.595) Conclusions: The study concluded that there was no significant difference in outcome in three modalities of treatment - topical, systemic and topical-systemic combined. So only topical antibiotics will do suffice in the treatment of CSOM, unless there is no sign of complications (like fever and/or pain). Ibrahim Cardiac Med J 2014; 4(1): 27-32

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Systemic Antibiotics Versus Topical Treatments for Chronic Discharging Ears with Underlying Eardrum Perforations

Journal of Dhaka Medical College ◽

10.3329/jdmc.v19i2.7075 ◽

1970 ◽

Vol 19 (2) ◽

pp. 86-90

Author(s):

SHIA Masum ◽

MAY Fakir

Keyword(s):

Otitis Media ◽

Combined Therapy ◽

Study Groups ◽

Behavioural Problem ◽

Chronic Suppurative Otitis Media ◽

Secondary Outcome ◽

Suppurative Otitis Media ◽

Topical Antibiotics ◽

Significant Difference ◽

Systemic Antibiotics

Context: Chronic suppurative otitis media (CSOM) is a common cause of preventable hearing impairment worldwide, particularly in low and middle-income countries. Untreated CSOM may result in permanent hearing loss, which in turn, may result in speech and language delays or permanent learning disabilities, as well as behavioural problem. Of the treatment options, the efficacy of using only topical antibiotics and combination of systemic antibiotics and topical antibiotics are most disputable. The present study was undertaken to investigate the role of adjuvant systemic antibiotics in the treatment CSOM. Methods: A randomized clinical trial was carried out on children with chronic suppurative otitis media at the ENT outpatient department of Dhaka Shishu Hospital from January to December 2009. Any patient presenting with a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane and a history of discharge for at least two weeks was considered as a case. A total of 112 cases of chronic suppurative otitis media were consecutively enrolled in the study. Of them, 72 completed 3rd follow up visit and hence, considered evaluable. Results: The results of the study demonstrated that the study groups were almost identical in terms of age, sex, socioeconomic class and residence. The peak age incidence of chronic suppurative otitis media was found between 4-6 years (around 75%). In both the groups, the patients were predominantly male, belonged to poor and lower middle class families and slum dwellers. No significant difference was observed between the study groups in terms of primary and secondary outcome as well as the complications encountered by the patients. Patients of who received combined therapy, 70% of them showed resolution of otorrhoea by 2 weeks and 95% by 3 weeks, which in the patients of topical antibiotics alone was 50% and 87.5% respectively. The trial did not show any adverse event except tinnitus complained by a few patients in both groups. Conclusion: Topical quinolone antibiotics (ciprofloxacin) are equally effective as topical plus oral antibiotics (ciprofloxacin) for resolution of otorrhoea from uncomplicated CSOM. However, for faster resolution of otorrhoea, a short course systemic antibiotic can be added. Key words: Chronic suppurative otitis media (CSOM); topical antibiotics; topical plus systemic antibiotics; primary outcome; secondary outcome. DOI: 10.3329/jdmc.v19i2.7075J Dhaka Med Coll. 2010; 19(2) : 86-90

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