Topical antibiotics with steroids

Topical antibiotics

Systemic antibiotics

Topical antiseptics

Aural toileting (ear cleaning)

Topical antibiotics with steroids

Review CSOM‐4

Topical antibiotics

Review CSOM‐4

Review CSOM‐1

Systemic antibiotics

Review CSOM‐4

Review CSOM‐3

Review CSOM‐2

Topical antiseptics

Review CSOM‐4

Review CSOM‐6

Review CSOM‐6

Review CSOM‐5

Aural toileting

Review CSOM‐4

Not reviewed

Not reviewed

Not reviewed

Review CSOM‐7

Placebo (or no intervention)

Review CSOM‐4

Review CSOM‐1

Review CSOM‐2

Review CSOM‐5

Review CSOM‐7

Class of antibiotics

Examples

Route of administration

Quinolones

Ciprofloxacin, ofloxacin, levofloxacin

Oral, intravenous, topical

Aminoglycosides

Gentamicin, tobramycin

Topical or parenteral

Neomycin/framycetin

Only topical

Cephalosporins

Ceftazidime

Parenteral

Penicillins

Ticarcillin plus clavulanic acid

Parenteral

Monobactams

Aztreonam

Parenteral

Antiseptic agent used aurally

Target and mechanism of action

Rubbing alcohol (ethanol, isopropanol)

Penetrating agents that cause loss of cellular membrane function, leading to release of intracellular components, denaturing of proteins, and inhibition of DNA, RNA, protein and peptidoglycan synthesis.

Povidone iodine

Highly active oxidising agents that destroy cellular activity of proteins. Disrupts oxidative phosphorylation and membrane‐associated activities. Iodine reacts with cysteine and methionine thiol groups, nucleotides and fatty acids, resulting in cell death.

Chlorhexidine

Membrane‐active agents that damage cell wall and outer membrane, resulting in collapse of membrane potential and intracellular leakage. Enhanced passive diffusion mediates further uptake, causing coagulation of cytosol.

Hydrogen peroxide

Produces hydroxyl free radicals that function as oxidants, which react with lipids, proteins and DNA. Sulfhydryl groups and double bonds are targeted in particular, thus increasing cell permeability.

Boric acid

It is likely that the change in the pH media of the ear canal interrupts the growth of bacteria by affecting the amino acid, which causes alteration in the three‐dimensional structure of bacterial enzymes. Extreme changes in pH cause protein denaturation.

Aluminium acetate/acetic acid

Acetic acid changes the pH media of the ear canal and interrupts the growth of bacteria by affecting the amino acid, which causes alteration in the three‐dimensional structure of bacterial enzymes. Extreme changes in pH cause protein denaturation. Aluminium acetate is an astringent that helps reduce itching, stinging and inflammation.