Hearing loss and balance disorders can be caused by commonly used antibiotic ear drops if the patient has a perforated eardrum, writes Associate Professor Harvey Coates in the April edition of Australian Prescriber.

These serious complications, the result of ototoxicity, may be more common than reported, as some cases are unrecognised.

Ototoxicity is associated with aminoglycosides which are an ingredient of the most frequently prescribed antibiotic ear drops in Australia. General practitioners therefore face a dilemma when prescribing antibiotic ear drops.

Aminoglycosides can cause ototoxicity within a few days when the eardrum has been perforated, the mastoid cavity is open, or a patent grommet is used.

He notes that best practice is to avoid using aminoglycoside drops if the patient has a perforation. The Australian Society of Otolaryngology Head and Neck Surgery recommends that if potentially ototoxic drops are used for discharging middle ears, they should be ceased as soon as the discharge stops.

Ciprofloxacin drops are registered for use in the ears by the TGA and are an alternative treatment. The cost of treatment should be considered as many patients will need a private prescription.

Ciprofloxacin is on the PBS for use in chronic suppurative otitis media in Aboriginal and Torres Strait Islander patients over the age of one month.

About Australian Prescriber

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by the National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is distributed every two months in hard copy to health professionals, free of charge, and online in full text at australianprescriber.

Australian Prescriber