Topical aminoglycosides in the management of active mucosal chronic suppurative otitis media

Lancaster, Jeffrey; Makura, Z. G. G.; Porter, Glen T.; McCormick, M

doi:10.1017/s002221510014304x

Cited by 9 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Topical aminoglycoside‐containing antibiotics continue to be used in the management of chronic suppurative otitis media with the feeling of many that the risk of ototoxicity from infection outweighs the risk from the antibiotic 3 . Topical therapy has the advantage of reducing systemic side‐effects, avoiding resistance selection in the gut flora, and achieving higher concentrations of drug at the site of action 4…”

Section: Discussionmentioning

confidence: 99%

Comparison of compliance between topical aural medications

et al. 2003

View full text Add to dashboard Cite

Patients receiving Gentisone HC, Sofradex and Otomize for chronic suppurative otitis media and otitis externa were investigated for compliance of medication. Drops were accurately weighed before and after use so that both the amount used and the expected amount patients should have used could be calculated. The amount used differed statistically from the amount expected for Sofradex (P = 0.0008) but not for Gentisone HC (P = 0.1049) or Otomize (P = 0.7553) when analysed by a Mann-Whitney U-test. There was a trend to overdose with both Sofradex & Gentisone HC. The reason for the differences, we believe, is due to a combination of both differing delivery systems and drop viscosities. Manufacturers need to improve delivery systems so that patients can deliver a reproducible volume of medication each time with ease.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of compliance between topical aural medications

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Justification for their use is still made on the belief of many that the relative risks of ototoxicity from untreated active mucosal disease far outweighs the equivalent risks of using the topical preparations. 1 However, a clear warning of potential ototoxicity when using aminoglycoside containing drops in any ear with a tympanic membrane perforation was published recently by the Committee on Safety of Medicine 9 and evidence is emerging of isolated cases of iatrogenic vestibulotoxicity with such topical preparations. 10 Despite this, current recommendations by the British Association of Otorhinolaryngologists, Head and Neck Surgeons suggest that their use in middle ear infections should not be discontinued as long as two precautions are observed; never use topical gentamicin in an uninfected ear and never prolong treatment further than 10 days.…”

Section: Discussionmentioning

confidence: 99%

“…Aminoglycoside‐containing topical preparations are widely used by otolaryngologists in the management of active mucosal CSOM within the UK. 1 Their frequency of use is related to their broad spectrum of antibacterial activity; in particular against the gram‐negative bacterium Pseudomonas aeruginosa , which is the most frequently cultured organism in mucosal CSOM. 2–3 Such preparations are used to treat episodes of acute mucosal infection, thus limiting periods of otorrhoea, which the patient may find unpleasant, and more importantly, reducing the risk of developing otogenic intracranial complications or sensorineural deafness.…”

mentioning

confidence: 99%

“…Debate currently exists regarding the relative risk of ototoxicity when using topical aminoglycoside‐containing drops in the management of active mucosal CSOM. 1 Most research has previously focussed on direct absorption through the round window membrane as the most likely route for ototoxicity. 6 Little data are available on systemic absorption and toxicity following topical aural administration.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Systemic absorption of gentamicin in the management of active mucosal chronic otitis media

1999

Self Cite

View full text Add to dashboard Cite

A prospective study was performed on patients with active mucosal chronic otitis media who were being treated with the gentamicin-containing preparation Gentisone HC. In 27 patients plasma gentamicin levels were measured. Detectable levels were found in 7/27 (26%). Pre- and post-treatment audiometry was performed on 16 patients. There was no statistically significant difference in the change of the mean bone conduction thresholds as a result of treatment, between the treatment and control ears (P = 0.07, Wilcoxon signed Ranks Test at 95% C.I.). We conclude that there is evidence of systemic absorption of gentamicin that would ultimately be absorbed into the perilymph. Gentamicin is known to be ototoxic affecting the vestibular system in lower doses and the cochlea in high doses, hence audiometric assessment is not an appropriate screen for ototoxicity when using topical gentamicin-containing drops. Alternative topical preparations should be further investigated.

show abstract

“…Neomycin, gentamicin, framycetin (Neomycin B) and tobramycin, are cochleotoxic while gentamicin is more vestibulotoxic than tobramycin 2 . Ototoxic damage to the vestibule and cochlear have been noted in ototopical treatment of chronic suppurative otitis media 3–7 including neomycin‐based eardrops 8–10 . In one Canadian study, 16 patients prescribed ototoxic eardrops developed cochlear and/or vestibular symptoms, with a number eventually being unable to work or being confined to a wheelchair secondary to labyrinthine symptoms.…”

Section: Potentially Ototoxic Components Of Eardrops Used In Australiamentioning

confidence: 99%

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

Coates

2005

J Paediatrics Child Health

View full text Add to dashboard Cite

Until recently the only available antibiotic eardrops for treatment of the discharging middle ear and mastoid cavity have been potentially ototoxic. With the advent of non-ototoxic fluoroquinolone eardrops, consensus panels in the USA, Canada and the UK have advocated the preferential use of these agents in the open middle ear. However, in Australia, no fluoroquinolone topical agent is approved for use with tympanic membrane perforations, and when used as an 'off label' eardrop, none is on the Pharmaceutical Benefits Scheme. This creates an ethical dilemma, particularly with best practice management of chronic suppurative otitis media in indigenous children. Despite concerns regarding resistance issues with ototopical use of systemic antibiotics, bacterial resistance has not been documented in major studies. For equity and ethical reasons, Australian regulatory authorities should consider approving a sterile non-ototoxic eardrop for use in the open middle ear.

show abstract

Topical aminoglycosides in the management of active mucosal chronic suppurative otitis media

Cited by 9 publications

References 16 publications

Comparison of compliance between topical aural medications

Comparison of compliance between topical aural medications

Systemic absorption of gentamicin in the management of active mucosal chronic otitis media

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

Contact Info

Product

Resources

About