Commonly prescribed quinolone eardrops may lead to perforated eardrum

FLORIDA: The commonly prescribed treatment for infection of the outer ear canal (acute otitis externa or swimmer's ear) -- quinolone eardrops may be doing more harm than good, suggests a recent study.

The study, published in the journal Clinical Infectious Diseases found that patients who were prescribed quinolone eardrop had a 60% higher risk of a perforated eardrum. The risk was double the risk in those who were prescribed neomycin, another common antibiotic ear drop.

Patrick J Antonelli, College of Medicine, University of Florida, Gainesville, Florida, and colleagues conducted the study to determine whether the use of quinolone ear drops increased the risk of perforation with intact tympanic membranes and acute otitis externa (AOE).

This retrospective cohort study used Medicaid clinical encounter and pharmacy billing records from 1999-2010. Children and adults had to have 24 months continuous enrollment in Medicaid prior to the first antibiotic ear drop dispensing (index date), and they had to maintain their enrollment for at least 18 months thereafter. Included ear drops were ofloxacin, ciprofloxacin plus hydrocortisone, ciprofloxacin plus dexamethasone, and neomycin plus hydrocortisone. A total of 94,333 patients entered the study cohort (43,653 used quinolones; 50,680 used neomycin drops).

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Key findings of the study include:

• Use of quinolone ear drops was associated with increased risk for tympanic membrane perforation (TMP) compared with neomycin plus hydrocortisone, with an adjusted hazard ratio of 2.26.


• 38 perforations occurred with quinolone drops (5.5 per 10,000 patient-years) vs 25 with neomycin drops (3.1 per 10,000 patient-years).


• For specific formulations, aHRs (95% CIs):
  
  
  
  • Ofloxacin: 2.53 (1.27-5.05);
  
  
  • Ciprofloxacin plus hydrocortisone: 2.24 (1.03-4.85); and
  
  
  • Ciprofloxacin plus dexamethasone: 2.30 (1.09-4.87).
  
  
  
  

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"Selection of otic preparations to treat self-limited conditions with intact tympanic membranes should consider TMP risk," concluded the authors.

For detailed study log on to https://doi.org/10.1093/cid/ciz345