{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T03:21:23Z","timestamp":1773285683516,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2016,11,21]],"date-time":"2016-11-21T00:00:00Z","timestamp":1479686400000},"content-version":"vor","delay-in-days":4648,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2004,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>There is growing concern over the use of systemic antibiotics and the development of bacterial resistance. The question remains as to whether ototopical medications may also promote antibiotic\u2010resistant organisms, either on a local level (in the ear) or in other areas of the aerodigestive tract. We performed an evidence\u2010based review to answer the following clinical question, \u201cDo antibiotic ototopical medications induce antibiotic resistant organisms?\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN<\/jats:title><jats:p>We performed a MEDLINE search of the published literature from 1966 to the present. We used appropriate search terms such as \u201cototopical antibiotics,\u201d \u201cototopical drops,\u201d \u201cantibiotic resistance,\u201d \u201ctopical antibiotics and otitis externa,\u201d \u201cotitis externa and treatment,\u201d \u201cotitis externa and antibiotic drops,\u201d \u201cotitis externa and ototopical drops,\u201d \u201cotitis media,\u201d \u201cotitis media and treatment,\u201d \u201cotitis media and antibiotic drops,\u201d \u201cchronic suppurative otitis media,\u201d \u201cchronic suppurative otitis media and treatment,\u201d \u201cchronic suppurative otitis media and antibiotic drops,\u201d \u201c otitis externa and resistant organisms,\u201d \u201cotitis media and resistant organisms,\u201d \u201cchronic suppurative otitis media and resistant organisms,\u201d \u201cophthalmic antibiotic drops,\u201d \u201cdraining ear,\u201d \u201cP.E. tube otorrhea,\u201d \u201cpressure equalizing tube otorrhea,\u201d \u201cpressure equalizing tube otorrhea and treatment,\u201d and \u201cpressure equalizing tube otorrhea and ototopical therapy\u201d to identify pertinent articles. These articles were reviewed and graded according to the evidence quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>After an initial screening of over 2,500 articles, 38 articles were analyzed further; of these, 11 were determined to warrant extensive review. Eight articles evaluated chronic suppurative otitis media; 2, otitis externa; and 1, post\u2010tympanostomy tube otorrhea, whereas 3 others studied systemic absorption. Of the 8 chronic suppurative otitis media studies, there were thought to be 5\u00a0grade 2B studies, 1\u00a0grade 1B study, and 1\u00a0grade 2C study. These studies did not demonstrate a propensity for the development of resistant organisms. No study answered the question as to whether resistance to systemic antibiotics might occur in otitis externa.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Overall grade B evidence seems to indicate that no significant antibiotic resistance develops from the use of ototopical antibiotic treatment.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.otohns.2003.12.009","type":"journal-article","created":{"date-parts":[[2004,3,30]],"date-time":"2004-03-30T05:20:36Z","timestamp":1080624036000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["The Development of Antibiotic Resistant Organisms with the Use of Ototopical Medications"],"prefix":"10.1002","volume":"130","author":[{"given":"Peter C.","family":"Weber","sequence":"first","affiliation":[{"name":"Department of Otolaryngology and Communicative Disorders Cleveland Clinic Foundation Cleveland Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S.","family":"Roland","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery The University of Texas Southwestern Medical Center Dallas Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Hannley","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2010Head and Neck Surgery Alexandria Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rick","family":"Friedman","sequence":"additional","affiliation":[{"name":"House Ear Clinic Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spiros","family":"Manolidis","sequence":"additional","affiliation":[{"name":"Bobby R. Alford Department of Otorhinolaryngology Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Matz","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Owens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Rybak","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Southern Illinois School of Medicine Springfield Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Bobby R. Alford Department of Otorhinolaryngology Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,11,21]]},"reference":[{"key":"e_1_2_1_2_1","first-page":"S345","article-title":"Strategies for decreasing multidrug antibiotic resistance: role of ototopical agents for treatment of middle ear infections","volume":"14","author":"Klein JO","journal-title":"Am J Manage Care 20028"},{"key":"e_1_2_1_3_1","first-page":"53","volume-title":"Bacterial Corneal Ulcers","author":"Stonecipher KG"},{"key":"e_1_2_1_4_1","volume-title":"Evidence\u2010based Medicine: How to Practice and Teach EBM","author":"Sackett DL","year":"2000"},{"key":"e_1_2_1_5_1","unstructured":"PhillipsB BallC SackettDL Levels of evidence and grades recommendation.http:\/\/cebm.jr2.ox.ac.uk\/docslevels.html."},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-5876(01)00648-6"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(98)80137-9"},{"key":"e_1_2_1_8_1","first-page":"207","article-title":"In vitro susceptibility of aural isolates of Pseudomonas aeruginosa to commonly used ototopical antibiotics","volume":"17","author":"Dohar JE","year":"1996","journal-title":"Am J Otol"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1995.01890120070014"},{"key":"e_1_2_1_10_1","first-page":"18","article-title":"The treatment of chronic suppurative otitis media and otitis externa with 0.3% ofloxacin otic solution: a clinicomicrobiological study","volume":"78","author":"Supiyaphun P","year":"1995","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_1_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1990.tb00425.x"},{"key":"e_1_2_1_12_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2000.107888"},{"key":"e_1_2_1_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.126.2.165"},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1997.01900110047007"},{"key":"e_1_2_1_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200207000-00005"},{"key":"e_1_2_1_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.5.537"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100139076"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1995.01890080048009"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.3.337"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.otohns.2003.12.009","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.otohns.2003.12.009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:37:17Z","timestamp":1760963837000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.otohns.2003.12.009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,3]]},"references-count":18,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2004,3]]}},"alternative-id":["10.1016\/j.otohns.2003.12.009"],"URL":"https:\/\/doi.org\/10.1016\/j.otohns.2003.12.009","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,3]]},"assertion":[{"value":"2016-11-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}