A meta-analysis of the efficacy of quinolone containing otics in comparison to antibiotic–steroid combination drugs in the local treatment of otitis externa

Abstract

Background:

The term otitis externa denotes the inflammation of the external auditory canal and can be treated locally in the form of monotherapy or a combination drug.

Objective:

The aim of the present meta-analysis was to compare the efficacy of an antibiotic–steroid combination drug with that of monotherapy. According to current data, a comparable investigation based on network analysis does not exist.

Methods:

After systematically searching the PubMed, Medline, Medpilot, Web of Science and Embase electronic databases, 12 relevant randomized, controlled, clinical studies were identified involving 2682 evaluable patients with regard to the cure rate and seven publications with 1251 microbiologically assessable patients. The collected data were compared directly and indirectly by means of network analysis.

Results:

The direct comparison showed a trend towards the superiority of the monotherapy containing quinolone. The network analysis verified this tendency and demonstrated that pure quinolone drugs can achieve a significantly higher cure rate (OR: 1.29; 95% CI: 1.06–1.57; p = 0.01) and a significantly superior eradication rate (OR: 1.44; 95% CI: 1.03–2.02; p = 0.03) compared to combination drugs not containing quinolone. We found substantial heterogeneity (with I² up to 88.7%) between studies, presumably due to treatments applied in varying frequency, thus bearing on compliance and outcome.

Conclusion:

With a level Ia evidence, this investigation validates the clinical benefit of quinolones as compared to classic combination drugs in the local treatment of acute otitis externa.

Key words::

• Antibiotics
• Glucosteroids
• Local treatment
• Meta-analysis
• Network analysis
• Otitis externa
• Quinolones

Transparency

Declaration of funding

This project was financed with university funding and an unrestricted research grant provided by Alcon Pharma GmbH, Germany. The sponsor took no influence on the preparation of the manuscript.

Declaration of financial/other relationships

R.M. has disclosed that he has received funding for his research from Alcon Pharma GmbH, Germany, and has acted as a scientific consultant for Alcon Inc., USA. The other authors have no conflicting financial or other interests to report. The present systematic review was performed in the context of a university research project.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Ralph Mösges and Mehregan Nematian-Samani contributed equally to this manuscript.

We thank Gena Kittel BA for assisting in the preparation of this manuscript.