Systematic review of topical antimicrobial therapy for acute otitis externa.

Abstract

OBJECTIVE:

To determine the efficacy of topical antimicrobials for acute otitis externa.

STUDY DESIGN:

Systematic review and random effects meta-analysis of randomized, controlled trials with parallel groups permitting one or more of the following comparisons: antimicrobial vs placebo, antiseptic vs antimicrobial, quinolone antibiotic vs nonquinolone antibiotic, steroid-antimicrobial vs antimicrobial, or antimicrobial-steroid vs steroid.

RESULTS:

Twenty trials met inclusion criteria and 18 had data suitable for pooling. Topical antimicrobials increased absolute clinical cure rates over placebo by 46% (95% confidence interval [CI], 29% to 63%) and bacteriologic cure rates by 61% (95% CI, 46% to 76%). No significant differences were noted in clinical cure rates for other comparisons, except that steroid alone increased cure rates by 20% compared with steroid plus antibiotic (95% CI, 3% to 38%). Quinolone drops increased bacteriologic cure rates by 8% compared with nonquinolone antibiotics (95% CI, 1% to 16%), but had statistically equivalent rates of clinical cure and adverse events.

CONCLUSION:

Topical antimicrobial is highly effective for acute otitis externa with clinical cure rates of 65% to 80% within 10 days of therapy. Minor differences were noted in comparative efficacy, but broad confidence limits containing small effect sizes make these of questionable clinical significance.

SIGNIFICANCE:

Summary estimates from the 13 meta-analyses can be used to facilitate evidence-based management recommendations and clinical practice guideline development.

• Authors: Richard M Rosenfeld, Michael Singer, Jared M Wasserman, Sandra S Stinnett
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 134 Issue 4 Suppl Pg. S24-48 (Apr 2006) ISSN: 0194-5998 [Print] England
• PMID: 16638474 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Anti-Bacterial Agents

Topics

• Acute Disease
• Administration, Topical
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Clinical Trials as Topic
• Humans
• Otitis Externa (drug therapy)
• Treatment Outcome