The development of antibiotic resistant organisms with the use of ototopical medications.
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?"


METHODS
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.
Weber
Peter C
PC
Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Roland
Peter S
PS
Hannley
Maureen
M
Friedman
Rick
R
Manolidis
Spiros
S
Matz
Greg
G
Owens
Fred
F
Rybak
Leonard
L
Stewart
Michael G
MG
D000208:Acute Disease; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002908:Chronic Disease; D004352:Drug Resistance, Microbial; D019317:Evidence-Based Medicine; D006801:Humans; D008876:Middle Ear Ventilation / Q000009:adverse effects; D010032:Otitis Externa / Q000188:drug therapy; D010033:Otitis Media / Q000188:drug therapy; D010035:Otitis Media, Suppurative / Q000188:drug therapy
D000900:Anti-Bacterial Agents