Successful treatment of malignant otitis externa with oral ciprofloxacin

AbstractTwo cases are presented, both patients with advanced maligant otitis externa.The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b. d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.

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Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002775 ◽

2006 ◽

Vol 121 (2) ◽

pp. 118-123 ◽

Cited By ~ 31

Author(s):

J M Bernstein ◽

N J Holland ◽

G C Porter ◽

A R Maw

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Externa ◽

White Cell Count ◽

Antibiotic Sensitivity ◽

Response To Treatment ◽

Reactive Protein ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Oral Ciprofloxacin

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

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Malignant Otitis Externa Resistant to Ciprofloxacin: Implications for Treatment

Skull Base ◽

10.1055/s-2009-1224419 ◽

2009 ◽

Vol 19 (S 02) ◽

Author(s):

T. Mandrali ◽

D. Assimakopoulos ◽

M. Karakitsou ◽

K. Proikas ◽

M. Tzagaroulakis

Keyword(s):

Otitis Externa ◽

Malignant Otitis Externa

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Faculty Opinions recommendation of Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736591788.793565073 ◽

2019 ◽

Author(s):

Chris Raine ◽

Huay Shan Yuen

Keyword(s):

Teaching Hospital ◽

Otitis Externa ◽

First Century ◽

Diagnosis And Management ◽

Malignant Otitis Externa ◽

Twenty First Century

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Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

Journal of Otology ◽

10.1016/j.joto.2020.01.004 ◽

2020 ◽

Vol 15 (3) ◽

pp. 112-116

Author(s):

K Devaraja ◽

Dipak Ranjan Nayak

Keyword(s):

Internal Jugular Vein ◽

Otitis Externa ◽

Jugular Vein ◽

Review Of Literature ◽

Jugular Vein Thrombosis ◽

Vein Thrombosis ◽

Malignant Otitis Externa ◽

Internal Jugular Vein Thrombosis

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651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

The Journal of Laryngology & Otology ◽

10.1017/s002221511500105x ◽

2015 ◽

Vol 129 (6) ◽

pp. 600-603 ◽

Cited By ~ 16

Author(s):

G Chawdhary ◽

N Liow ◽

J Democratis ◽

O Whiteside

Keyword(s):

Otitis Externa ◽

Severe Infection ◽

Fold Increase ◽

Antibiotic Resistant ◽

Catchment Population ◽

Malignant Otitis Externa ◽

The Mean ◽

The Uk ◽

High Index Of Suspicion ◽

Park Hospital

AbstractBackground:Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.Methods:A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.Results:There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).Conclusion:Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

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