Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Ear Diseases/drug therapy , Administration, Topical , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/toxicity , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/toxicity , Evidence-Based Medicine , Humans , SafetyABSTRACT
OBJECTIVE: The objective of this study was to systematically review the literature on animal ototoxicity from ototopical medications. A secondary objective was to assess the relevance of animal data to the use of ototopical drops in clinical situations involving humans. STUDY DESIGN: We performed a MEDLINE search of the published literature using appropriate search terms to identify pertinent articles, which were reviewed, summarized, and tabulated. RESULTS: One hundred seventy-three articles were reviewed; 61 articles were appropriate to the study question and were further analyzed. CONCLUSIONS: Virtually all studies demonstrate that aminoglycoside antibiotics, when applied topically into the middle ear space, are ototoxic in experimental animals.
Subject(s)
Anti-Bacterial Agents/toxicity , Ear, Middle/drug effects , Administration, Topical , Animals , Anti-Bacterial Agents/administration & dosage , Humans , Round Window, Ear/drug effects , Time Factors , Tympanic Membrane Perforation/drug therapyABSTRACT
OBJECTIVE: We sought to determine the incidence of injury to the cochlea or vestibular system from the use of ototopic antibiotic ear drops. STUDY DESIGN: We conducted a MEDLINE search of the published literature from 1966 to the present using the search items of "ototopic antibiotics," "ototopic drops," "antibiotic resistance," and others to identify pertinent articles. These articles were reviewed and graded according to evidence quality. Forty-four articles were found; 27 articles were considered appropriate for review and 14 of these articles were thought to warrant further extensive review. The latter 14 articles dealt directly with the evaluation of either hearing loss or changes in vestibular function after the use of ototopic ear drops. We eliminated studies that did not consider hearing or vestibular function. We considered only articles in the English language, eliminating articles that not address the ototoxicity of ototopical ear drops. RESULTS: Most of these articles were in the level 3 to 3b category. Two of the articles were in the 1b category, evaluating evidence-based studies. An article that reviewed case reports of ototopical ototoxicity and a survey article are included in this study, as case reports of ototopical ototoxicity and survey articles. CONCLUSION: We found a total of 54 cases of gentamicin vestibular toxicity and, in 24 of these patients, cochlear toxicity was also documented. Our review also found 11 cases of cochlear and 2 cases of vestibular toxicity in neomycin-based ear drops.
Subject(s)
Anti-Bacterial Agents/toxicity , Cochlea/drug effects , Gentamicins/toxicity , Vestibule, Labyrinth/drug effects , Administration, Topical , Anti-Bacterial Agents/administration & dosage , Gentamicins/administration & dosage , Hearing Loss/diagnosis , Humans , Neomycin/administration & dosage , Neomycin/toxicity , Vestibular Function TestsSubject(s)
Anti-Bacterial Agents/administration & dosage , Otitis Externa/drug therapy , Otitis Media, Suppurative/drug therapy , Otitis Media/drug therapy , Acute Disease , Administration, Topical , Adult , Aminoglycosides/administration & dosage , Aminoglycosides/toxicity , Anti-Bacterial Agents/toxicity , Child , Chronic Disease , Fluoroquinolones/administration & dosage , Fluoroquinolones/toxicity , Humans , Middle Ear VentilationABSTRACT
OBJECTIVE: There is growing concern over the use of systemic antibiotics and the development of bacterial resistance. The question remains as to whether ototopical medications may also promote antibiotic-resistant organisms, either on a local level (in the ear) or in other areas of the aerodigestive tract. We performed an evidence-based review to answer the following clinical question, "Do antibiotic ototopical medications induce antibiotic resistant organisms?" STUDY DESIGN: We performed a MEDLINE search of the published literature from 1966 to the present. We used appropriate search terms such as "ototopical antibiotics," "ototopical drops," "antibiotic resistance," "topical antibiotics and otitis externa," "otitis externa and treatment," "otitis externa and antibiotic drops," "otitis externa and ototopical drops," "otitis media," "otitis media and treatment," "otitis media and antibiotic drops," "chronic suppurative otitis media," "chronic suppurative otitis media and treatment," "chronic suppurative otitis media and antibiotic drops," " otitis externa and resistant organisms," "otitis media and resistant organisms," "chronic suppurative otitis media and resistant organisms," "ophthalmic antibiotic drops," "draining ear," "P.E. tube otorrhea," "pressure equalizing tube otorrhea," "pressure equalizing tube otorrhea and treatment," and "pressure equalizing tube otorrhea and ototopical therapy" to identify pertinent articles. These articles were reviewed and graded according to the evidence quality. RESULTS: After an initial screening of over 2,500 articles, 38 articles were analyzed further; of these, 11 were determined to warrant extensive review. Eight articles evaluated chronic suppurative otitis media; 2, otitis externa; and 1, post-tympanostomy tube otorrhea, whereas 3 others studied systemic absorption. Of the 8 chronic suppurative otitis media studies, there were thought to be 5 grade 2B studies, 1 grade 1B study, and 1 grade 2C study. These studies did not demonstrate a propensity for the development of resistant organisms. No study answered the question as to whether resistance to systemic antibiotics might occur in otitis externa. CONCLUSIONS: Overall grade B evidence seems to indicate that no significant antibiotic resistance develops from the use of ototopical antibiotic treatment.
