Chronic suppurative otitis media (CSOM) is an infection of the middle ear with pus and a persistent perforation in the eardrum. It is a common cause of preventable hearing impairment, particularly in low and middle-income countries. This review compares alternative topical treatments (antibiotics or antiseptics) with systemic (e.g. oral or injected) antibiotics, to identify which is best. Nine randomised controlled trials were included (833 randomised participants; 842 analysed participants or ears); most were poorly reported and some included a range of diagnoses.
Quinolone antibiotic drops such as ciprofloxacin were better than oral or injected antibiotics at drying the ear. This was found when compared to systemic quinolone or non-quinolone antibiotics. No benefit of adding systemic treatment to topical antibiotics was detected, although evidence was limited. The effects of topical non-quinolone antibiotics (without steroids) or antiseptics were less clear when compared to systemic treatment. Less is known about longer-term outcomes (producing a dry ear in the long-term, preventing complications, healing the eardrum, and improving hearing), or about treating complicated CSOM. The evidence in these trials about safety is also weak. More research is needed to assess whether there may be fewer adverse events with topical quinolones than with alternative topical or systemic treatments.