Topical versus oral antibiotics, with or without corticosteroids, in the treatment of tympanostomy tube otorrhea.
OBJECTIVE
Antibiotic treatment is the standard of care for tympanostomy tube otorrhea. This meta-analysis aims to evaluate the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children.


METHODS
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ProQuest.


METHODS
The above databases were searched using a search strategy for randomized controlled trials for optimal treatment of tube otorrhea in the pediatric population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Primary outcome was cure (i.e. clearance of otorrhea) at 2-3 weeks. Secondary outcomes were microbiological eradication and complications such as dermatitis and diarrhea. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) and number needed to benefit (NNTB) in a random-effects model.


RESULTS
We identified 1491 articles and selected 4 randomized controlled trials which met our inclusion criteria. Topical treatment had better cure (NNTB = 4.7, pooled RR = 1.35, p < 0.001) and microbiological eradication (NNTB = 3.5, pooled RR = 1.47, p < 0.001 among 3 of the studies) than oral antibiotics. Oral antibiotics had higher risk of diarrhea (pooled RR = 21.5, 95% CI 8.00-58.0, p < 0.001, Number needed to harm (NNTH) = 5.4) and dermatitis (pooled RR = 3.14, 95% CI 1.20-8.20, p = 0.019, NNTH = 32). The use of topical steroids in addition to topical antibiotics was associated with a higher cure rate (pooled RR = 1.59, p < 0.001 vs pooled RR = 1.57, p = 0.293).


CONCLUSIONS
Topical antibiotics should be the recommended treatment for management of tympanostomy tube otorrhea in view of its significantly improved clinical and microbiological efficacy with lower risk of systemic toxicity as compared to oral antibiotics. Further research is necessary to confirm the benefits of topical corticosteroids as an adjunct to topical antibiotics.
National University Health System, Singapore. Electronic address: cheejeremy@gmail.com.
Jeremy
J
Chee
National University Health System, Singapore.
Khang Wen
KW
Pang
Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore.
Jui May
JM
Yong
Department of Psychological Medicine, University Medicine Cluster, National University Health System, Singapore.
Roger Chun-Man
RC
Ho
Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore.
Raymond
R
Ngo
D000284:Administration, Oral; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D008876:Middle Ear Ventilation / Q000009:adverse effects*; D010034:Otitis Media with Effusion / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
Otitis media; Tube otorrhea; Tympanostomy