Clinical need for ototopical fluoroquinolones outweighs miniscule risk of antibiotic resistance

[Extract] The National Aboriginal Community Controlled Health Organisation (NACCHO), in a double-blind randomized controlled trial, showed that the use of topical ciprofloxacin to treat chronic suppurative otitis media (CSOM) among 111 Aboriginal children improved the odds of clinical cure three fold compared with the current standard of topical aminoglycoside. Treatment did not lead to resistant isolates isolates when followed up for 21 days, even among those with persistent discharge. Given the demonstrated efficacy and concerns about ototoxicity of aminoglycosides, it was recommended that ototopical ciprofloxacin be used as first-line treatment (in conjunction with ear toilet) for CSOM. Dr Coates correctly concludes in his review article that the theoretical concerns of resistance emerging from ototopical fluoroquinolones in this setting were considerably outweighed by the risk of bacterial resistance emerging from oral use