[From the Cochrane Library: topical antibiotic treatment is more effective than systemic antibiotic treatment for chronic otitis media with eardrum perforation and purulent discharge].

Chronic suppurative otitis media with underlying persistent eardrum perforation is a common cause of preventable hearing impairment. A Cochrane systematic review compared topical treatment (antibiotics or antiseptics) with systemic antibiotics to identify which is best. Nine randomised controlled trials were included (833 randomised patients; 842 analysed patients or ears). Topical treatment with quinolones was more effective in stopping (purulent) discharge than systemic treatment with quinolones or non-quinolones. No benefit from adding systemic treatment to topical antibiotics was detected. The effects of topical non-quinolone antibiotics or antiseptics were not clear. Little is known about secondary outcomes (prevention of complications, healing the eardrum, and improving hearing) or about the efficacy and safety of topical antibiotics in the long term.