P04.05 Topical Versus Systemic Antibiotic Therapy In The Treatment Of Acute Otitis External

A. I. Silva1, H. Aguiar2, J. L. Fernandes1, S. B. Cardoso3;
1USF Nova Salus, VILA NOVA DE GAIA, Portugal, 2USF Vale do Vouga, SÆo JoÆo da Madeira, Portugal, 3USF Salvador Lordelo, Valongo, Portugal.
Ana Isabel Silva
Unidade de Sa£de Familiar Nova Salus
Email: anisabelfs@gmail.com
Phone: 968625354
Background: Acute otitis externa (AOE) is an inflammation of the external auditory channel (EAC), with or without infection, lasting less than 6 weeks. Symptoms may include itching, ear pain, discharge and decreased hearing. The most frequent micro-organisms are Pseudomonas aeruginosa and Staphylococcus aureus. Both can cause infections in EAC for which the use of broad-spectrum antibiotics is necessary for an effective treatment. In recent years, several authors reported the use of topical antibiotics (TABs) as an alternative to systemic antibiotics (SABs) with high success rates.
Objective: To determine the effectiveness and advantages of TABs, or a combination therapy with TABs and SABs, comparatively to SABs alone, in the treatment of AOE in paediatric and adult populations.
Methodology: We conducted a survey of clinical practice guidelines, systematic reviews, meta-analysis and randomized controlled clinical trials (RCTs) in Pubmed, evidence-based medicine (EBM) databases, Portuguese Index of medical journals and references from selected articles, published between 01/2003 and 04/2011 in English and Portuguese languages, using the MeSH terms: ?otitis externa? and ?anti-bacterial agents?. Assessment of levels of evidence and strength of recommendation was established using American Family Physician?s Strength of Recommendation Taxonomy (SORT).
Results: 45 articles were retrieved: 6 of which met the criteria for inclusion: 1 System, 3 guidelines and two systematic reviews (SR). All articles consistently supported isolated TABs for the treatment of uncomplicated OAE, as a result of its effectiveness and lower potential for side effects or development of bacterial resistances. TABs permits antibiotics? lower doses and shorter courses, with additional advantages in terms of adherence, costs, and, especially, lower ototoxicity. In contrast, SABs exposes patients to the risk of developing resistances. SABs, alone or in combination, increase costs and the occurrence of adverse systemic side effects, while decreasing adherence to treatment.
Discussion: Available evidence indicates that TABs are the first-line treatment for the treatment of mild to moderate AOE (SOR B). TABs permit lower resistance rates, side effects and costs, compared with SABs or combined therapy (SOR B). Heterogeneity was an issue in selected studies. Further high quality studies are needed for the evaluation of interventions in the AOE.
Topical versus systemic antibiotic therapy in the treatment of Acute Otitis External