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Antibiotic ear drops favored over popular oral antibiotics for ear infections

December 13, 2006

A multicenter study on treating common ear infections in children with ear tubes adds to a growing body of evidence that favors antibiotic ear drops over antibiotics swallowed in pill or liquid form in such cases, a UT Southwestern Medical Center researcher reports.

The latest study, involving 80 children, showed that antibiotic ear drops performed better and faster in treating middle ear infections in children with ear tubes than merely taking oral antibiotics such as swallowing a pill or liquid. The findings are available online in the journal Pediatrics.

"With the use of ear drops, you can put more potent medicine just where you need it," said Dr. Peter Roland, chairman of otolaryngology at UT Southwestern and one of the study's authors.

The latest study looked at children ages 6 months to 12 years who had ear tubes, middle ear infections, and visible drainage in the ear. Both the oral and topical antibiotics cure the infections in more than 70 percent of cases. But the topical drops resolved the ear drainage three to five days faster and resulted in more clinical cures overall - 85 percent for those taking drops, compared to 59 percent for oral administration of medication - according to the study.

That's in line with previous research and other findings that support increased use of topical antibiotics over oral antibiotics in other cases involving middle ear infections, one of the most common childhood afflictions, said Dr. Roland, who heads the Clinical Center for Auditory, Vestibular and Facial Nerve Disorders at UT Southwestern and who is also chief of pediatric otology at Children's Medical Center Dallas.

Middle ear infections are the most common diagnosis for which children receive antibiotics, and insertion of ear tubes is the most common surgery performed on children.

Many doctors treat these infections with oral antibiotics like amoxicillin, which is absorbed through the blood stream, said Dr. Roland.

The tubes, researchers reported, provide better access to the middle ear, behind the ear drum, so more of the ear drops medicine reach the infection, avoiding potential intestinal and blood absorption that occurs with oral antibiotics. Researchers discovered that the concentration at the infection can be a thousandfold greater than when oral or IV medication is used.

In addition, because the antibiotic is not distributed throughout the body, there is less chance of developing antibiotic resistance.

Dr. Roland has previously demonstrated that middle ear infections are often caused by micro-organisms that are not susceptible to antibiotics approved for pediatric patients. But the ear infections are sensitive to topical ear drops. That research showed that children with ear tubes have different micro-organisms than those without the tubes, thereby requiring different treatment.

Previous research has shown other advantages to topical antibiotics for middle-ear infections as well:

- They tend to be more tolerable for children, so parents are more likely to comply with the whole regimen.

- They tend to cause fewer gastrointestinal problems, such as diarrhea, gastroenteritis, dermatitis or complications from yeast infections than the oral antibiotics.

- They lead to less antibiotic resistance, a major goal of the Centers for Disease Control and Prevention since 1995.

UT Southwestern Medical Center