Topical treatments better than systemic antibiotics for chronically discharging ears

Clinical question: 
What is the most effective treatment for chronic suppurative otitis media (CSOM)?
Bottom line: 
Topical quinolone antibiotics are better than systemic antibiotics for clearing discharge at up to 2 weeks in adults and children with CSOM. There is no benefit from combining systemic and topical treatments. The results are less clear for topical non-quinolone antibiotics (without steroids) or antiseptic when compared with systemic quinolone or non-quinolone antibiotics. Compared with topical quinolines, topical chloramphenicol plus systemic non-quinolones increases the risk of ototoxicity and hearing loss (NNH* 2–5). * NNH = number needed to treat to cause harm in one individual.
The outcome measured here is reduction in ear discharge. Little is known about longer term outcomes such as persisting dry ear, preventing complications, healing the eardrum and improved hearing.
CSOM is a common cause of preventable hearing impairment, particularly in low and middle-income countries. Aural toilet was usually only done once before starting treatment.
Review CD#: 
July, 2007
Authored by: 
Brian R McAvoy