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.
Caveat: 
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.
Context: 
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#: 
CD005608
PEARLS No: 
1
Date: 
July, 2007
Authored by: 
Brian R McAvoy
File: