If fluid from the middle ear space is draining out of the ear in a child with an acute ear infection (acute otitis media), there must be an opening in the eardrum – the air-tight membrane that separates the middle ear from the ear canal and helps us to hear. If fluid can get out through this opening, then it makes sense that medicine might get in. Researchers at the Children’s Hospital of Pittsburgh evaluated 80 children who had acute otitis media that was draining through ear tubes that the children already had in place. Half of the children received strong oral antibiotics, twice a day for ten days; the other half received antibiotic drops directly in the ear, twice a day for seven days. Those who got oral antibiotics received about 1000 times more antibiotic than those who got the drops: 90mg of antibiotics for every kg of body weight daily (the average age child in the study would weigh a little more than 12 kg, so over 900 mg daily total); those who received drops received only 0.84 mg total every day, whether they weighed 8 kg or 38 kg.
The results appeared September 2006 in Pediatrics. Even though the drops delivered 1000 times less antibiotics, they went straight to the source of the infection, rather than being spread throughout the body. The drops were more than 25% more likely to clear the infection entirely. The drops worked on average 42% faster. The drops had dramatically fewer side effects (there was an almost 30% side effect rate from the oral antibiotics!). Beyond all of this, I am most concerned that about 10% of the patients who took oral antibiotics had already acquired new bacteria in the ear during treatment; new bacteria did not emerge in any children who received drops. Antibiotic drops worked better, faster, with fewer side effects, and less risk of developing bacterial resistance. I can’t see why for most kids with a draining ear you would choose oral antibiotics as the first line of treatment.