title: Ototopical neomycin exposure in children with nonintact tympanic membranes.
abstract: OBJECTIVE
  Although contraindicated, neomycin otic preparations may be administered to children with nonintact tympanic membranes (TMs), such as tympanostomy tubes or TM perforations. The goal of this study was to assess the magnitude of neomycin exposure in children with nonintact TMs.
  
  
  METHODS
  Retrospective drug utilization study.
  
  
  METHODS
  Medicaid claims data (years 1999-2006) from 28 states for children aged 0 to 18 years were analyzed to identify new cases of tube placement or TM perforation. Cases were followed for 12 months to determine neomycin otic utilization.
  
  
  RESULTS
  Of the 300,470 children with nonintact TMs, neomycin otic preparations were prescribed in 43,815 (15%). Nontoxic agents (ofloxacin or ciprofloxacin) were used in 48%. In 19%, neomycin preparations were prescribed at the day of initial nonintact TM diagnosis, 52% and 71% within the first 3 or 6 months, respectively. Neomycin otic utilization decreased from 27% in cases diagnosed in 1999 to 7% in 2005 (P < .0001).
  
  
  CONCLUSIONS
  Many children with nonintact TMs receive exposure to agents with potential ototoxicity, despite the availability of safer alternatives. Further study is necessary to determine why neomycin otic preparations continue to be prescribed in the presence of nonintact TMs and if such exposure is associated with ototoxicity.
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
authors.forename: Almut G
authors.initials: AG
authors.lastname: Winterstein
authors.forename: Juan M Hincapie
authors.initials: JM
authors.lastname: Castillo
authors.forename: Dandan
authors.initials: D
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Antonelli
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000633:toxicity*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008876:Middle Ear Ventilation / Q000009:adverse effects*; D009355:Neomycin / Q000633:toxicity*; D012189:Retrospective Studies; D014432:Tympanic Membrane / Q000187:drug effects*; D018058:Tympanic Membrane Perforation / Q000150:complications*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D009355:Neomycin