Sounding a caution about ear drops

Antibiotic ear drops have become the preferred treatment for some ear infections, specifically those in children with surgically inserted ear tubes who still have problems. Because the medication is restricted to the infection site, doctors had hoped the drops would stem overuse of oral antibiotics, which has contributed to drug-resistant bacteria.

But this treatment also appears to encourage growth of resistant microbes. Dr. Glenn Isaacson, an ear, nose and throat specialist at Temple University School of Medicine in Philadelphia, examined two sets of cultures from the infected ears of young children with tubes who didn’t respond to treatment. The first set was from children treated principally with oral antibiotics in 1997-98; the second set was from children predominantly treated with antibiotic drops in 2002-03.

They found a “tremendous increase” in the incidence of fungal infections and resistant staph infections in the youngsters’ ear canals, he told colleagues at a Jan. 25 regional meeting of the American Laryngological, Rhinological and Otological Society.

These infections can be persistent and painful, requiring months of treatment.

“There was a simple, good treatment we were using for years that wasn’t doing this. Now we’ve all been persuaded to use a much more expensive, broad-spectrum antibiotic of questionable value that is clearly causing overgrowth by fungi and highly resistant bacteria,” Isaacson said. He suggested that doctors rethink the standard practice of using the drops first.

Some doctors point out that the drops may be given inappropriately, contributing to antibiotic resistance in the same way oral drugs do.