Chronic Suppurative Otitis Media Medication

Updated: Jun 19, 2023
  • Author: Denny Varughese, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print

Medication Summary

An expert panel of the American Academy of Otolaryngology-Head and Neck Surgery has provided guidelines for the use of antibiotics in chronic suppurative otitis media (CSOM). [42] The panel concluded that topical antibiotics alone constitute first-line treatment for most patients, barring systemic infection. If systemic infection is present, oral or, if necessary, parenteral antibiotics are warranted.

Although studies suggest only a slight risk of sensorineural hearing loss in humans from short courses of topical aminoglycosides, the risk of vestibular toxicity appears to be much higher.

The introduction of fluoroquinolones, which have no potential for ototoxicity, relegates aminoglycosides to a secondary treatment alternative in most areas. Patients who receive aminoglycoside drops when fluoroquinolone drops are available and subsequently develop sensorineural hearing loss or balance disturbance may blame their physician.

A retrospective Korean study, by Park et al, found that in patients with CSOM or chronic cholesteatomatous otitis media, methicillin-resistant Staphylococcus aureus (MRSA) infections demonstrated greater resistance to the antibiotics ciprofloxacin, clindamycin, erythromycin, gentamicin, levofloxacin, and tetracycline than they did in patients with otitis media with effusion or acute otitis media. [43]


Antibiotics/Corticosteroids, Otic

Class Summary

Topical and systemic antibiotics are used in the treatment of CSOM. Fluoroquinolone otic preparations, with or without a corticosteroid, are excellent options for topical treatment. Aminoglycoside otics may also be used, but monitoring of vestibular or cochlear toxicity is necessary. Representative examples of each class are listed below.

Ciprofloxacin (Cetraxal)

Ciprofloxacin is an ototopical fluoroquinolone containing hydrocortisone. This class of antimicrobial has a broad spectrum of activity. Additionally, fluoroquinolones do not cause vestibular or cochlear toxicity recognized with aminoglycosides.

Ciprofloxacin/dexamethasone combination (Ciprodex)

This combination of drugs treats bacterial infection and decreases the inflammation associated with bacterial infections.

Tobramycin (Tobrex)

Tobramycin is an ototopical aminoglycoside that may be combined with a corticosteroid. It has a long, successful history in the treatment of CSOM and is widely used today. The risk of vestibular or cochlear toxicity with prolonged use or use on the noninflamed middle ear exists; consider this when choosing to treat CSOM with this class of medication.

Tobramycin and dexamethasone (TobraDex)

This combination of drugs treats bacterial infection and decreases the inflammation associated with bacterial infections.


Piperacillin inhibits the biosynthesis of cell wall mucopeptides and the stage of active multiplication; additionally, piperacillin shows antipseudomonal activity.

Ceftazidime (Fortaz, Tazicef)

Studies show ceftazidime to be an effective IV antibiotic for the systemic treatment of CSOM. [24, 25] It penetrates the middle ear mucosa effectively and does not cause vestibular or cochlear toxicity.