Chronic Suppurative Otitis Media: Optimizing Initial Antibiotic Therapy in a Tertiary Care Setup

Abstract

A prospective study was done to determine the clinico-microbiological profile and the antibiogram of patients with chronic suppurative otitis media. Ninety-four patients presenting with tympanic perforation and ear discharge of more than 3 months were studied. Middle ear swabs obtained aseptically were processed for culture and the isolates identified by standard procedures. Antimicrobial susceptibility testing of the aerobic bacterial isolates was performed by disc diffusion method according to clinical laboratory standards institute guidelines. Patients in the age group of 21-30 years were more commonly affected (22.3%). Male:Female ratio was 2:1.4. Of the 94 patients, 64 (68.1%) had tubo-tympanic disease and rest 30 (31.9%) presented with attico-antral disease. Monomicrobial flora was seen in 55 (58.5%) samples, 28 (29.8%) yielded polymicrobial growth and 11 (11.7%) samples were sterile. A total of 115 microbial isolates (86 aerobic bacteria, 18 anaerobic bacteria and 11 fungi) were obtained. Pseudomonas aeruginosa (32.2%) was the most common isolate followed by Staphylococcus aureus (17.4%). Amongst anaerobes, gram positive cocci were more commonly isolated (38.9%). Aspergillus spp. (72.7%) were the most common fungus isolated. Most of the Pseudomonas aeruginosa isolates (25, 67.6%) were susceptible to all the antibiotics. Among the commonly used topical agents in the treatment of CSOM, tobramycin was the most effective (83.8%), followed by gentamicin (78.1%), ciprofloxacin (75.6%) and neomycin (3.5%). Periodic monitoring of the microbiological profile along with their sensitivity pattern is essential for formulating an effective antibiotic policy for CSOM.

Middle Ear and Nasopharyngeal Bacterial Flora and Their Sensitivity in Active Stage of Mucosal Disease Otitis Media: A Comparison

“…Similar bacterial isolates were noted by Choi et al [8]. P. aeruginosa and S. aureus were the frequent isolates observed by studies from our country as well as our neighboring countries too [3,7,[9][10][11][12]. Park et al [13] too have noted methicillin-resistant S. aureus (24.8%) in their isolates.…”

“…Male preponderance was observed in our study in line with previous studies [3]. Although we could not establish a relationship between profession and the disease occurrence, more number of students were affected.…”

“…Similar observation involvement (76.36%) was seen by Kabir et al and mucosal disease (tubotympanic type) was the most frequent (90%) [4]. Vishwanath et al too observed that mucosal disease (tubotympanic) is more frequent (68.1%) [3].…”

Prevalence of Pseudomonas aeruginosa in CSOM cases at a tertiary care centre

“…[7][8][9][10][11][12] Sensitivity rate of P. aeruginosa to ciprofloxacin in our study was 96%. This rate is comparable to various studies mentioned above.…”

“…This observation is compatible with the findings in other reports where negative cultures were documented. 7,12,13 There were no fungal isolates in our study.…”