Repurposing Povidone-Iodine for the Treatment of Chronic Suppurative Otitis Media in Nigerian Children

Background: Chronic suppurative otitis media (CSOM) is inflammation of the lining of the middle ear cleft. It is a leading cause of pediatric hearing loss. Antibiotic eardrops are CSOM’s mainstay of treatment, but with emerging resistance and increasing treatment failure, the need to explore other treatment options has become pertinent. Study Design: This was an 18-month randomized clinical trial of children aged 6 months to 14 years with uncomplicated CSOM, randomized into 3 intervention groups: (a) 0.5% povidone-iodine aural irrigation and oral amoxicillin-clavulanic acid, (b) 0.3% ciprofloxacin aural drops and oral amoxicillin-clavulanic acid, (c) 0.5% povidone-iodine aural irrigation alone. Treatment was for 4 weeks, with postintervention assessments at 4 weeks and 3 months. Results: A total of 361 cases completed the study. Otorrhea resolutions were comparable, at 92.7%, 93.7%, and 92.7% for groups a, b, and c, respectively. The proportion of healed tympanic membranes for the groups was 11.7%, 12.7%, and 15.6% for groups a, b, and c. With treatment, the absence of pathologic isolates across groups was 75%, 80.3% and 74.5% for groups a, b and c, respectively. Conclusion: This study shows that 0.5% povidone-iodine aural irrigation is at least as effective as 0.3% ciprofloxacin otic suspension in treating uncomplicated CSOM. In addition, any benefit from the use of oral antibiotics in treating uncomplicated CSOM appears to be negligible.