Chronic purulent otitis media: modern approaches to therapy
Suppurative chronic otitis media can develop with untreated otitis media. The report presents data on the effectiveness of various approaches in the treatment of this disease.
Chronic suppurative otitis media (HCHO) is a bacterial infection of the middle ear that can develop with untreated otitis media.
In order to assess the efficacy of various treatment regimens for chronic suppurative otitis media, a search for articles was undertaken for the period from 1966 to 1996. in MEDLINE and the bibliographic collection of the Hearing Impairment Research Group (UK). Twenty-four randomized trials evaluating the different treatment modalities for patients with perforated eardrum and persistent otorrhea were selected. The studies involved 1,660 patients. The assessment was carried out by three independent experts. The clinical signs and severity of HCGS varied.
Antibiotic or antiseptic treatment combined with an ear sink was more effective in resolving the symptom of otorrhea compared to no treatment (2 studies, odds ratio (OR) 0.37, confidence interval (CI) 95 % 0.24-0.57) or only treatment of the ear cavity (6 studies, OR 0.31, 95% CI 0.23-0.43). Antibiotic therapy or topical antiseptic showed higher efficacy compared to systemic antibiotic therapy (6 studies, OR 0.46, 95% CI 0.30-0.69), while the combination of local and systemic antibiotics was not more effective than just local therapy. There was no difference in the effectiveness of antibiotics and local antiseptics (3 studies, OR 1.34, 95% CI 0.64-2.81). The incidence of adverse reactions was low and did not differ significantly when using all regimens.
Among the antibacterial drugs studied, fluoroquinolones for topical application were the most effective (5 studies, OR 0.26, 95% CI 0.16-0.41). Ciprofloxacin hydrochloride is currently considered the gold standard in the treatment of chronic suppurative otitis media, studies confirm its higher clinical and biological efficacy, as well as the absence of ototoxicity. However, the widespread use of the drug has led to an increase in resistance to fluoroquinolones, especially with long treatments.
In a prospective randomized study by C. Jaya and colleagues (India), 40 HCC patients received 5% topical povidone iodine or 0.3% ciprofloxacin (ear drops) 3 drops 3 times daily for 10 days. The observation was carried out weekly for 4 weeks from the start of treatment.
Clinical improvement was observed in 88% of patients on povidone iodine and in 90% of patients on ciprofloxacin. The most common pathogen was Pseudomonas aeruginosa. No resistance of pathogens in vitro to povidone iodine was detected. In 17% of microorganisms, resistance to ciprofloxacin was detected. In the two patients in whom ciprofloxacin therapy was ineffective, resistant strains were isolated.
Clinically, the efficacy of topical povidone-iodine therapy was not less than that of ciprofloxacin. Its advantages are the absence of risk of developing resistance, as well as the lower cost of treatment.