amoxicillin-potassium-clavulanate-combination and Tympanic-Membrane-Perforation

The insertion of grommets (also known as ventilation or tympanostomy tubes) is one of the most common surgical procedures performed on children. Postoperative otorrhoea (discharge) is the most common complication with a reported incidence ranging from 10% to 50%. In the UK, many ENT surgeons treat with topical antibiotics/steroid combinations, but general practitioners, mainly through fears of ototoxicity, are unlikely to prescribe these and choose systemic broad-spectrum antibiotics.. 1. To identify the most effective non-surgical management of discharge from ears with grommets in place.2. To identify the risks of non-surgical management for this condition (e.g. ototoxicity), and to set benefits of treatment against these risks.. We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to 2005) and EMBASE (1974 to 2005). We also searched the CINAHL, AMED, LILACS, ISI WEB OF KNOWLEDGE, ISI PROCEEDINGS, mRCT, NNR, ZETOC, KOREAMED, CSA, MEDCARIB, INDMED and SAMED databases. The date of the last search was February 2005.. Randomised controlled trials of adults or children, with any type of grommet and an ear with discharge were included. The trials compared treatment with placebo or one treatment with another. The primary outcome measure was the duration of the discharge.. The trials were selected independently according to the above criteria by the four reviewers. Differences in opinion over the inclusion of studies were resolved by discussion. The studies were graded using the CASP critical appraisal tool. Analyses were based on the presence of discharge seven days from the onset of treatment.. There was very little good quality evidence. Four studies were included, all of them investigating different interventions and therefore a meta-analysis was not possible.Only one study demonstrated a significant difference. Oral amoxicillin clavulanate was compared to placebo in 79 patients. The odds of having a discharge persisting eight days after starting treatment was 0.19 (95% CI 0.07 to 0.49) . The number needed to treat to achieve that benefit is 2.5. Participants in both arms of this study also received daily aural toilet. The results will therefore not be applicable to most settings including primary care. No significant benefit was shown in the two studies investigating steroids (oral prednisolone with oral amoxicillin clavulanate and topical dexamethasone with topical ciprofloxacin ear drops), or the one study comparing an antibiotic-steroid combination (Otosporin®) drops versus spray (Otomize®) (although more patients preferred the spray form).. The authors of this review have been unable to identify the most effective intervention or to assess the associated risks. Research is urgently needed into the effectiveness of oral versus topical antibiotics in this group of patients. Clinicians considering antibiotic treatment need to balance any potential benefit against the risks of side effects and antibiotic resistance.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cerebrospinal Fluid Otorrhea; Child; Ciprofloxacin; Dexamethasone; Drug Combinations; Humans; Hydrocortisone; Middle Ear Ventilation; Neomycin; Otitis Media, Suppurative; Polymyxin B; Randomized Controlled Trials as Topic; Tympanic Membrane Perforation

The insertion of grommets (also known as ventilation or tympanostomy tubes) is one of the most common surgical procedures performed on children. Postoperative otorrhoea (discharge) is the most common complication with a reported incidence ranging from 10% to 50%. In the UK, many ENT surgeons treat with topical antibiotics/steroid combinations, but general practitioners, mainly through fears of ototoxicity, are unlikely to prescribe these and choose systemic broad-spectrum antibiotics.. 1. To identify the most effective non-surgical management of discharge from ears with grommets in place.2. To identify the risks of non-surgical management for this condition (e.g. ototoxicity), and to set benefits of treatment against these risks.. We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to 2005) and EMBASE (1974 to 2005). We also searched the CINAHL, AMED, LILACS, ISI WEB OF KNOWLEDGE, ISI PROCEEDINGS, mRCT, NNR, ZETOC, KOREAMED, CSA, MEDCARIB, INDMED and SAMED databases. The date of the last search was February 2005.. Randomised controlled trials of adults or children, with any type of grommet and an ear with discharge were included. The trials compared treatment with placebo or one treatment with another. The primary outcome measure was the duration of the discharge.. The trials were selected independently according to the above criteria by the four reviewers. Differences in opinion over the inclusion of studies were resolved by discussion. The studies were graded using the CASP critical appraisal tool. Analyses were based on the presence of discharge seven days from the onset of treatment.. There was very little good quality evidence. Four studies were included, all of them investigating different interventions and therefore a meta-analysis was not possible. Only one study demonstrated a significant difference. Oral amoxicillin clavulanate was compared to placebo in 79 patients. The odds of having a discharge persisting eight days after starting treatment was 0.19 (95% CI 0.07 to 0.49) . The number needed to treat to achieve that benefit is 2.5. Participants in both arms of this study also received daily aural toilet. The results will therefore not be applicable to most settings including primary care. No significant benefit was shown in the two studies investigating steroids (oral prednisolone with oral amoxicillin clavulanate and topical dexamethasone with topical ciprofloxacin ear drops), or the one study comparing an antibiotic-steroid combination (Otosporin(R)) drops versus spray (Otomize(R)) (although more patients preferred the spray form).. The authors of this review have been unable to identify the most effective intervention or to assess the associated risks. Research is urgently needed into the effectiveness of oral versus topical antibiotics in this group of patients. Clinicians considering antibiotic treatment need to balance any potential benefit against the risks of side effects and antibiotic resistance.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cerebrospinal Fluid Otorrhea; Child; Ciprofloxacin; Dexamethasone; Drug Combinations; Humans; Hydrocortisone; Middle Ear Ventilation; Neomycin; Otitis Media, Suppurative; Polymyxin B; Randomized Controlled Trials as Topic; Tympanic Membrane Perforation

To compare postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty.. This is a prospective, randomized controlled study conducted in children of age 6-15 years with chronic otitis media (COM) mucosal, inactive type undergoing myringoplasty. Postoperative infection over a period of 4 weeks and status of graft at or around 3 months after surgery was studied as outcome measure.. Fifty five out of sixty children completed follow-up. The overall postoperative infection rate was 5.4%. Postoperative infection rate was 3.5% in children receiving prophylactic antibiotic and 7.4% in children receiving no antibiotic. There was no statistically significant difference in postoperative infection between two groups (P > 0.05). The overall graft uptake rate was 87.27%. It was 85.7% in antibiotic used group and 88.8% in non-antibiotic group with no statistically significant difference (P > 0.05).. Postoperative infection following myringoplasty in children is uncommon as it is a clean type of surgery. There was no statistically significant difference in postoperative infection and graft uptake rate by the use of prophylactic antibiotic in the intraoperative period. This study shows no benefit of a prophylactic antibiotic on postoperative infection or graft success in myringoplasty in children.. NCT03700814.

Topics: Administration, Intravenous; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Chronic Disease; Female; Follow-Up Studies; Humans; Male; Myringoplasty; Otitis Media; Postoperative Complications; Prospective Studies; Treatment Outcome; Tympanic Membrane Perforation

The authors aim to analyze the effects of oral antibiotic treatment for traumatic tympanic membrane perforations and to compare the outcomes of patients with traumatic tympanic membrane perforation after paper-patching procedure and spontaneous healing.In this study, 80 patients with traumatic tympanic membrane perforation diagnosed in the otorhinolaryngology emergency department and outpatient clinic from March 2010 to January 2015 were retrospectively reviewed. If the patient is diagnosed at first week and the edge of perforation is moist with blood, our routine procedure is paper-patching (group 1). However, if the patients reject treatment or delay in admission, the authors follow up patients for spontaneous closure (group 2). Some of the patients got oral antibiotics for 7 days (amoxicillin/clavulanic acid, 1000 mg 2 times/d) while some others did not. Closure rates and effectivity of oral antibiotics were evaluated and compared between 2 groups.In total, 80 patients were analyzed. The closure rates of perforations were 95.2% for group 1 (n = 42) and 81.6% for group 2 (n = 38). Although the paper-patched patients (group 1) perforation closure rate (95.2%) is higher than the nontreated patients (group 2) closure rate (81.6%), it is not statistically significant (P > 0.05). Antibiotic administered 55 patients had a significantly higher closure rate (94.5%) than the 25 patients who are not treated with antibiotics (76%) (P = 0.023; P < 0.05).In patients with traumatic tympanic membrane perforations, spontaneous closure rate is quite high. This study showed us that antibiotherapy and paper-patch treatments increase the healing rates.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Child; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myringoplasty; Paper; Retrospective Studies; Tympanic Membrane; Tympanic Membrane Perforation; Wound Healing; Young Adult