Article: Aminoglycoside-containing eardrops: avoiding ototoxicity and choosing safer alternatives.

I have no problem using aminoglycoside-containing topical antibiotic drops in the presence of an intact tympanic membrane. However, a major problem could arise when a patient has a defect in a tympanic membrane--for example, a ventilation tube or a perforation--that might allow these drops to be absorbed into the inner ear via the round window membrane. Under these circumstances, I prefer to use a topical quinolone, which in my practice has been every bit as effective.

If there is no alternative but to use an aminoglycoside, then I do so carefully; I prescribe it for the shortest duration necessary and certainly for no longer than 5 or 7 days without reviewing ...

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