Use of Polysporin Antibiotic Ear Drops in COVID-19 Patients with Sinus Congestion
Polysporin ear drops should not be used for sinus congestion in COVID-19 patients, as topical ear antibiotics are not indicated for upper respiratory symptoms and routine antibiotic use is strongly discouraged in COVID-19 without evidence of bacterial infection. 1
Why Polysporin Ear Drops Are Not Appropriate
Polysporin (neomycin/polymyxin B) ear drops are formulated specifically for external ear canal infections, not for sinus congestion or upper respiratory symptoms. The medication cannot reach the sinuses when applied to the ear canal and has no therapeutic role in treating nasal or sinus congestion. 2
Sinus congestion in COVID-19 is typically viral in nature and does not require antibiotic therapy. The prevalence of bacterial coinfection in COVID-19 patients is only 5.1%, making routine antibiotic use inappropriate. 1
Evidence-Based Approach to Antibiotics in COVID-19
When Antibiotics Are NOT Indicated
Antibiotics should not be routinely prescribed for COVID-19 patients, even with respiratory symptoms like sinus congestion. Prescription should be based on clinical justifications including disease severity, radiographic imaging showing bacterial infection, and laboratory data. 1
Over 70% of COVID-19 patients received antibiotics despite only 5-8% having actual bacterial infections, representing significant overuse. This overuse increases antimicrobial resistance, adverse events, and healthcare costs. 1, 3
When to Consider Antibiotics for Sinusitis
Antibiotics may be warranted only when specific criteria are met:
Critically ill patients requiring ICU admission or mechanical ventilation have higher risk of bacterial coinfection (adjusted relative risk 1.41). 1, 2
Laboratory markers suggesting bacterial infection: WBC elevation, significantly elevated CRP, or procalcitonin >0.5 ng/mL. However, biomarkers alone should not determine antibiotic initiation in non-critically ill patients. 1, 2
Radiographic evidence of bacterial sinusitis: sinus opacification with air-fluid levels on imaging. 2
Proper Diagnostic Workup
Obtain comprehensive microbiologic cultures (blood, sputum) before starting empirical antibiotics to facilitate appropriate adjustment, de-escalation, or discontinuation. 1, 2
Use procalcitonin levels <0.25 ng/mL to guide withholding or early discontinuation of antibiotics in mild-to-moderately ill patients. 1
Appropriate Management for Sinus Congestion in COVID-19
Symptomatic treatment is the appropriate approach: antipyretics, hydration, nasal saline irrigation, and decongestants as needed. 4
If bacterial sinusitis is confirmed (not just congestion), appropriate systemic antibiotics would be oral agents like amoxicillin-clavulanate or respiratory fluoroquinolones, not topical ear drops. 2, 5
Critical Pitfalls to Avoid
Do not use topical ear antibiotics for sinus or upper respiratory symptoms - this represents inappropriate medication use with no therapeutic benefit. 2
Avoid prescribing antibiotics based solely on COVID-19 diagnosis or viral upper respiratory symptoms without evidence of bacterial superinfection. This contributes to antimicrobial resistance. 1, 6
Be aware that steroid use in COVID-19 may predispose to secondary bacterial and fungal infections, including invasive fungal sinusitis, though routine prophylactic antibiotics are still not recommended. 6, 7