A study published in Clinical Infectious Diseases found that children with tympanostomy tube placement exposed to quinolone ear drops had a higher risk of perforation requiring tympanoplasty, an association further pronounced by corticosteroids.

Study authors performed a retrospective cohort study using Medicaid and pharmacy billing data from 29 states between 1996–2006. Patients aged <18 years without predisposing factors for perforation during a 6-month look-back period entered the cohort after tympanostomy tube placement and first dispensing of antibiotic ear drops.

The ear drops studied were quinolones (eg, ofloxacin, ciprofloxacin + hydrocortisone, ciprofloxacin + dexamethasone) or neomycin + hydrocortisone. The patients were tracked until the end of 2006, end of Medicaid enrollment, or occurrence of study outcome.  

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In the study cohort including 96,595 children, those exposed to quinolone ear drops had an increased risk of perforation (adjusted hazard ratio [aHR] 1.61, 95% CI: 1.15–2.26). The aHR were 1.49 (95% CI: 1.05–2.09) for ofloxacin, aHR 1.94 (95% CI: 1.32–2.85) for ciprofloxacin + hydrocortisone, and aHR 2.00 (95% CI: 1.18–3.41) for ciprofloxacin + dexamethasone. 

The findings indicate a higher risk of perforations requiring tympanostomy among children exposed to quinolone ear drops. “Clinicians should consider the risk of perforation and counsel patients/families accordingly when prescribing quinolone ear drops,” concluded lead author Adel Alrwisan. 

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