The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding).
A Cochrane review [Abstract] 1 included 9 studies with a total of 2 132 children aged 0-12 years. The included studies compared the effects and safety of a wide range of interventions in children with grommets who develop ear discharge beyond the immediate postoperative period. Four studies compared antibiotic eardrops (with or without corticosteroids) to oral antibiotics. Eardrops included ciprofloxacin in 2 studies, ofloxacin in 1 study and bacitracin-colistin in 1 study, and the oral antibiotic was amoxicillin-clavulanate in 3 studies and amoxicillin in 1 study.
For the primary outcome of proportion of patients with resolution of ear discharge at short-term follow-up, data from only 1 study (n=42) could be used. Children treated with ciprofloxacin eardrops were more likely to have resolution of ear discharge at 1 week than those treated with oral amoxicillin (77% versus 30%; RR 2.58, 95% CI 1.27 to 5.22, NNTB 3).
For the secondary outcome of proportion of patients with resolution of ear discharge at intermediate-term follow-up, data from 3 studies was used. Resolution of ear discharge at 2 to 4 weeks was improved with antibiotic-corticosteroid eardrops compared to oral antibiotics (RR 1.59, 95% CI 1.35 to 1.88; 2 studies, n=232, NNTB 8), but there was no difference between antibiotic-only eardrops compared to oral antibiotics (RR 1.00, 95% CI 0.91 to 1.09; 1 study, n=233). In the sensitivity analysis including only studies judged as low risk of bias for allocation concealment and incomplete outcome data, only one study (n=153) was included. Children treated with bacitracin-colistin-hydrocortisone eardrops were more likely to have resolution of ear discharge at 2 weeks than those treated with oral amoxicillin-clavulanate (95% versus 56%; RR 1.70, 95% CI 1.38 to 2.08, NNTB 3).
There were no significant differences in adverse events occurrence between antibiotic eardrops and oral antibiotics; no serious complications occurred in either of the groups.
Another meta-analysis 2 included 4 RCTs evaluating the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children. It found improved clinical and microbiological efficacy with lower risk of systemic toxicity with topical antibiotics compared to oral antibiotics.
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