An antibiotic gel could treat kids’ ear infections with one dose

That time you had to pin down your crankypants kid every day for a week to give them antibiotics for an ear infection? One-time ear drops could some day end that drama.

Scientists at Boston Children’s Hospital want to commercialize an antibiotic gel that slowly seeps through the intact eardrum, hoping it will bring relief to millions of wailing kids and their exhausted parents. They’ve tested it so far on 10 chinchillas with positive results, published Wednesday in Science Translational Medicine. No word from the researchers on whether the chinchillas were crankypants themselves.

Why it matters:

Otitis media, the ear infection, is the most common diagnosis in US children, especially in kids under 5, and the most common reason they take antibiotics. The standard treatment — a week or more of liquid antibiotics, given by mouth multiple times per day — is tough on kids, tough on their parents, and can wipe out the good bacteria in a child’s digestive system. And not finishing the full course can contribute to antibiotic resistance in kids, said study coauthor Dr. Daniel Kohane, a researcher at Children’s.

You’ll want to know:

It’s hard to get antibiotics to permeate an intact eardrum to reach the inner ear, where infectious bacteria end up. Doctors only give ear drops to a kid with an ear infection if the eardrum is already perforated. In this study, researchers used a heat-sensitive hydrogel, which is liquid at room temperature, to slide the antibiotics down the ear canal. When the mixture hits the warm eardrum, it firms up into a gel, where it soaks through the eardrum for about a week, said lead author Rong Yang, a postdoctoral fellow in Kohane’s lab. To get through the eardrum, she said, the team used chemicals that disrupt, but don’t destroy, the thin membrane. Yang found that the method cured all 10 chinchillas of their ear infections, and the drug stayed local to the ear, sparing the chinchillas the diarrhea that often comes with oral medicines.

What they’re saying:

“If that pans out, it would be awesome,” said Dr. Mary Brown, a pediatrician at Tufts Medical Center who was not involved in the study. It often takes two people to hold a child and squirt antibiotics into his or her mouth, she said. Lots of oral medicine dribbles out of kids’ mouths, so doctors have to use a larger volume of medicine to make sure enough gets swallowed. Ear drops “still may require two people to hold kids down, depending on how squirmy they are,” Brown said. But she sees a big advantage: “They can’t spit it out.”

But keep in mind:

Not every kid needs antibiotics. Some ear infections are caused by viruses, where antibiotics won’t help. And doctors are moving away from immediately giving antibiotics to every kid with an ear infection, said Dr. David McCormick, professor of pediatrics at the University of Texas Medical Branch in Galveston. McCormick studied a method called watchful waiting, in which doctors stay in touch with parents to monitor symptoms and give antibiotics only if the infection does not seem to be resolving itself. He found that many ear infections clear up on their own. The American Academy of Pediatrics is now recommending doctors discuss that option with parents, depending on the child’s age and the severity of the symptoms.

Next steps:

Kohane and Yang want to commercialize the ear drops. Some of the components of their product are already FDA-approved, and some are not, Kohane said, so they aren’t sure how long the approval process will take. Yang said she’s optimistic because the chinchilla has a similar ear structure and range of hearing to humans. In human trials, they plan to watch out for one side effect they saw in chinchillas: temporary hearing loss, which researchers likened to having your ears clogged up with wax.

The bottom line:

Scientists say the research could change the way we treat the most common illness in American kids, but it’s too soon to say whether the ear drops will make it out of the lab and into the doctor’s office.