Ototopical neomycin exposure in children with nonintact tympanic membranes

Objectives/Hypothesis: Although contraindicated, neomycin otic preparations may be administered to children with nonintact tympanic membranes (TMs), such as tympanostomy tubes or TM perforations. The goal of this study was to assess the magnitude of neomycin exposure in children with nonintact TMs....

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Bibliographic Details
Published in:The Laryngoscope 2012-11, Vol.122 (11), p.2529-2532
Main Authors: Winterstein, Almut G., Castillo, Juan M. Hincapie, Xu, Dandan, Liu, Wei, Antonelli, Patrick J.
Format: Article
Language:English
Subjects:
Adolescent
aminoglycoside
Anti-Bacterial Agents - toxicity
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Child
Child, Preschool
Drug toxicity and drugs side effects treatment
Female
Humans
Infant
Infant, Newborn
Level of Evidence: 2b
Male
Medicaid - statistics & numerical data
Medical sciences
Middle Ear Ventilation - adverse effects
neomycin
Neomycin - toxicity
Otorhinolaryngology. Stomatology
Ototoxicity
Pharmacology. Drug treatments
Retrospective Studies
Toxicity: respiratory system, ent, stomatology
Tympanic Membrane - drug effects
Tympanic Membrane Perforation - complications
United States
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Summary:Objectives/Hypothesis: Although contraindicated, neomycin otic preparations may be administered to children with nonintact tympanic membranes (TMs), such as tympanostomy tubes or TM perforations. The goal of this study was to assess the magnitude of neomycin exposure in children with nonintact TMs. Study Design: Retrospective drug utilization study. Methods: Medicaid claims data (years 1999–2006) from 28 states for children aged 0 to 18 years were analyzed to identify new cases of tube placement or TM perforation. Cases were followed for 12 months to determine neomycin otic utilization. Results: Of the 300,470 children with nonintact TMs, neomycin otic preparations were prescribed in 43,815 (15%). Nontoxic agents (ofloxacin or ciprofloxacin) were used in 48%. In 19%, neomycin preparations were prescribed at the day of initial nonintact TM diagnosis, 52% and 71% within the first 3 or 6 months, respectively. Neomycin otic utilization decreased from 27% in cases diagnosed in 1999 to 7% in 2005 (P < .0001). Conclusions: Many children with nonintact TMs receive exposure to agents with potential ototoxicity, despite the availability of safer alternatives. Further study is necessary to determine why neomycin otic preparations continue to be prescribed in the presence of nonintact TMs and if such exposure is associated with ototoxicity. Laryngoscope, 2012
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.23554