Is topical antibiotic use for otitis media considered antibiotic abuse?

  Although there has long been more controversy about topical antibiotics as a method of delivery, topical antibiotics have been used for many years in the treatment of conditions such as bacterial otitis externa and otitis media, and antibiotic ear drops are still widely used by otologists. Antibiotic ear drops are commonly used in patients with otitis media, and antibiotic oil gauze is routinely filled in the operative cavity following middle ear surgery.  In view of the current situation of antibiotic abuse, in 2004, the Ministry of Health, the State Administration of Traditional Chinese Medicine, and the Ministry of Health of the General Logistics published the Guidelines for Clinical Application of Antibacterial Drugs, which recommended that “local application of antibacterial drugs should be avoided as much as possible: after local application of antibacterial drugs to the skin and mucous membranes, they are rarely absorbed and cannot reach an effective concentration at the infection site, which in turn is likely to cause allergic reactions or lead to However, the guidelines add that “local application of antimicrobial drugs is limited to a few cases, for example, when it is difficult to achieve therapeutic concentrations at the site of infection after systemic administration, local administration can be added as an adjunctive treatment. …… Certain skin surface and oral and vaginal mucosal surface infections For example, when it is difficult to achieve therapeutic concentration at the site of infection after systemic administration, local administration can be added as an adjunctive treatment. Certain skin surface and oral, vaginal and other mucosal surface infections can be treated with local application or topical application of antibacterial drugs, but local application of species mainly for systemic application should be avoided. Aminoglycosides and other ototoxic drugs should not be used as topical ear drops.”  For limited soft tissue infections, the systemic application of antibiotics has a high cost, systemic toxic adverse reactions, and it is difficult to achieve and maintain the high concentration required for local anti-inflammatory sterilization and other deficiencies, so that people naturally think of the local application of antibiotics. Local application of antibiotics does not work through injections or medications, but by applying antibiotics directly to the site of need. Topical antibiotics have been used to treat limited soft tissue infections because they are simple, safe and effective.  The advantages of local application of antibiotics: 1, can be accurately delivered at the required site, and the drug concentration of dozens or even hundreds of times than the systemic application of antibiotics; 2, can quickly reach the peak drug concentration in the local and maintain for a long time; 3, although the local drug concentration is very high, but the total amount of drugs and the amount of drugs into the blood circulation is less than the systemic drugs, and therefore will not produce toxic adverse reactions to the important organs of the body; 4, when the local soft tissue infection occurs. When a local soft tissue infection occurs or after surgical debridement, due to the body’s natural defense mechanism, this area is lack of blood supply, and the local application of antibiotics can directly act on the lesion site, without the blood to carry the drug to this area, so the local ischemia of the lesion does not affect the efficacy.  Of course, in addition to allergies and drug resistance, there is significant damage to soft tissue, especially nerve tissue, due to high local drug concentrations, which is why ototoxic antibiotics are absolutely contraindicated for direct use against infections in the ear.