Safety and efficacy of ciprofloxacin in the management of pediatric post-tympanostomy tube otorrhea: a systematic review and meta-analysis
In brief
Ciprofloxacin halves post-tube ear discharge risk in children
A meta-analysis of four randomized trials involving 1,025 kids showed ciprofloxacin, given as drops or sustained-release injections, cut the chance of post-tympanostomy tube otorrhea by roughly 50% compared with placebo, with no safety signals. The finding supports using ciprofloxacin for prevention or treatment, though larger real-world studies are still needed.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 19 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Baraa Awad, Danah Mansour Altewairgi, Shahad Elyas, Alanoud Alaslab, Reema Altwairqi, Atheer Allehyani, et al.
- PMID
- 42472949
- DOI
- 10.1007/s00405-026-10396-5
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 26 July 2026): Ciprofloxacin reduces post‑tympanostomy tube otorrhea
Abstract
PURPOSE: This systematic review and meta-analysis aim to evaluate the efficacy and safety of Ciprofloxacin compared to alternative treatments for managing PTTO. METHODS: A comprehensive search was carried out in PubMed, MEDLINE, Springer, and Embase. Randomized controlled trials and interventional studies were included if they assessed Ciprofloxacin in children (0-18 years) with PTTO following tympanostomy tube insertion. The primary outcomes analyzed were clinical resolution of otorrhea, time to resolution, recurrence rates, and adverse effects. For the meta-analysis, only studies comparing Ciprofloxacin to placebo were included to minimize heterogeneity, and outcomes were analyzed using a random effects model with risk ratios and 95% confidence intervals via RevMan 5.4 software. RESULTS: Out of 704 identified records, four randomized controlled trials met the inclusion criteria, comprising a total of 1,025 pediatric patients aged 6 months to 14 years. These studies evaluated Ciprofloxacin, either as topical drops or sustained-release intratympanic injections, against a placebo for the prevention or treatment of PTTO. All studies reported that Ciprofloxacin significantly reduced the incidence of otorrhea compared to placebo, with relative risk reductions ranging from approximately 46% to 66%. The pooled meta-analysis of 892 participants demonstrated a statistically significant reduction in otorrhea with Ciprofloxacin treatment (risk ratio 0.53; 95% confidence interval 0.35 to 0.79; p = 0.002), with no observed heterogeneity (I² = 0%). CONCLUSION: This systematic review and meta-analysis demonstrated that ciprofloxacin, whether administered as topical drops or sustained-release formulations, reduces post-tympanostomy tube otorrhea in children without significant safety concerns.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.