Ototoxic eardrops and tympanic membrane perforations: Time for a change?

Coates, Harvey

doi:10.1111/j.1440-1754.2005.00657.x

Cited by 4 publications

(7 citation statements)

References 22 publications

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“…Co ciekawe, obawa przed ototoksycznym działaniem miejscowo stosowanego leku wśród lekarzy rodzinnych jest wyższa niż wśród lekarzy otolaryngologów [17]. W ostatnich latach wzrasta liczba spraw sądowych wytaczanych lekarzom w tych przypadkach, głównie w USA, Kanadzie i Australii [26]. Udokumentowanych przypadków ototoksycznego działania miejscowo podanego leku potencjalnie ototoksycznego jest stosunkowo niewiele.…”

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Bezpieczeństwo miejscowego dousznego stosowania leków w różnych sytuacjach klinicznych

Wysocki¹,

Bartoszewicz²

2013

Polski Przegląd Otorynolaryngologiczny

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Słowa kluczowe: ucho zewnętrzne ucho środkowe ostre zapalenie przewlekłe zapalenie drenaż leczenie miejscowe bezpieczeństwo efektywność Keywords: External ear Middle ear External otitis Acute otitis Chronic otitis Eardrum drainage Topical treatmentSafety Efficacy a b s t r a c t Drugs administered directly into the ear canal are used for otitis externa, chronic chronic otitis media and, in some cases, acute inflammation of the middle ear in children with eardrum grommets. In some clinical conditions eardrum is incomplete or absent, or, at the preserved/reconstructed tympanic membrane, the rear wall of the ear canal is open to the antrum. Drugs applied topically to the external auditory canal are acidifying preparations, antiseptic substances and antibacterial or antifungal antibiotics, steroids and also heavy metals in colloidal form. Aminoglycosides, formerly appearing as the most common component of these drugs, because of the very high potential for ototoxicity, gradually disappear from the group of fluoroquinolone antibiotics. Numerous clinical studies have shown high therapeutic efficacy of these compounds in the absence of ototoxicity. In view of the possibility of obtaining a high concentration of antibiotic in the site of infection, and the absence of adverse effects, typical for systemic administration of the drug, they are recommended as monotherapy in chronic otitis externa, exacerbated chronic otitis media, and in cases of acute otitis media in children with grommets.

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“…W tych przypadkach wręcz zaleca się stosowanie miejscowej terapii antybiotykiem i sterydem. Na tej podstawie także badacze z innych krajów postulują dopuszczenie tych antybiotyków do stosowania miejscowego w swoich krajach [26]. Odrębny problem stanowi miejscowe leczenie zapaleń ucha środkowego u dzieci z drenażem jam bębenkowych.…”

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Bezpieczeństwo miejscowego dousznego stosowania leków w różnych sytuacjach klinicznych

Wysocki¹,

Bartoszewicz²

2013

Polski Przegląd Otorynolaryngologiczny

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“…We read with interest the opinion of Coates 1 about ear drops and tympanic membrane perforations. While we strongly agree that it is ‘time for a change’ away from topical aminoglycosides, we do not agree that the change should be to fluoroquinolones.…”

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Time for a Change? Yes, but Not to Ciprofloxacin

Turnidge

Christiansen

2006

J Paediatrics Child Health

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quently required, leading to repeated antibiotic exposure and greater selection pressure for resistance. Hence, selecting for resistance with topical fluoroquinolone therapy for non-serious infections or for 'prophylaxis' puts the value of this class for truly serious infections under threat.To make our position clear, we are not strong supporters either of the use of topical aminoglycosides on resistance grounds. Aminoglycosides are also valuable antibiotics for serious infections. However, we know that neomycin, which is not used systemically, does not necessarily select for resistance to the standard systemic aminoglycosides such as gentamicin, and therefore not all topical aminoglycosides are alike. Unfortunately, using one fluoroquinolone topically will necessarily select for resistance to a range of valuable fluoroquinolones.The clinical problem addressed by Coates is a troublesome one, but rather than following his suggestions to lobby a wide range of groups to get ready access to ciprofloxacin ear drops, we believe that prescribers should urgently lobby the pharmaceutical industry to produce a safe and effective antimicrobial ear drop that does not have resistance implications for valuable reserve systemic antimicrobials. Australia has been very effective at controlling resistance to fluoroquinolones. We would like to keep it that way. References

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“…Given the demonstrated efficacy and concerns about ototoxicity of aminoglycosides, it was recommended that ototopical ciprofloxacin be used as first‐line treatment (in conjunction with ear toilet) for CSOM. Dr Coates correctly concludes in his review article that the theoretical concerns of resistance emerging from ototopical fluoroquinolones in this setting were considerably outweighed by the risk of bacterial resistance emerging from oral use 2 …”

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“…Proponents arguing that Aboriginal children should be denied access to this medication should also be aware that ototopical fluoroquinolones are widely used ‘off‐label’ in Australia by those who can afford it 2 . Thus, current supply arrangements ‘ration’ ototopical fluoroquinolones on the basis of who can afford to pay – which is obviously unacceptable.…”

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confidence: 99%