[Choice of ear drops in chronic otorrhea].
In chronic otitis, the use of ear drops has certain advantages over the use of systemic antibiotics. The choice of ear drop depends on the condition of the eardrum, microbial pathogens present and the efficacy of the components of the ear drop. Ototoxicity, contact allergy and the development of bacterial resistance have to be taken into account. Ototoxicity is a rare complication of the application of ear drops, most often described when aminoglycosides were applied. Contact allergy is also most often seen in aminoglycoside-containing eardrops. Evaluation of ear swabs demonstrated a 5% resistance of Pseudomonas aeruginosa to ciprofloxacin. The appearance of resistant strains may impede systemic use of fluoroquinolones. Therefore, this class of antibiotics should be considered as reserve medication only. The first choice in local application of antiseptics in case of an open eardrum is aluminium acetotartrate 1.2% and, of a combination preparation, bacitracin-colistin-hydrocortisone. In case of a closed eardrum (external otitis) aluminium acetotartrate 12%--combination preparations with corticosteroids are advised against in these cases.
Mylanus
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Afd. Keel-, Neus- en Oorheelkunde, Universitair Medisch Centrum St. Radboud, HB Nijmegen. e.mylanus@kno.azn.nl
Natsch
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Mulder
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Meis
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D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001414:Bacitracin / Q000627:therapeutic use; D002908:Chronic Disease; D003091:Colistin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004431:Ear, External; D006801:Humans; D006854:Hydrocortisone; D009426:Netherlands; D010035:Otitis Media, Suppurative / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013644:Tartrates / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000893:Anti-Inflammatory Agents; D013644:Tartrates; C041214:acetotartaric acid; D001414:Bacitracin; D006854:Hydrocortisone; D003091:Colistin