Evolving Resistant Pseudomonas to Ciprofloxacin in Malignant Otitis Externa

Berenholz, Leonard P.; Katzenell, Udi; Harell, Moshe

doi:10.1097/00005537-200209000-00017

Cited by 99 publications

(93 citation statements)

References 13 publications

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“…However, oral Fluoroquinolones like Ciprofloxacin have far superior antipseudomonal action, replacing the need for intravenous antimicrobials, along with excellent penetration into bones, making them the drugs of choice for MOE [41][42][43]. Another advantage offered by Quinolones has been safe administration in elderly diabetics with an already deranged renal functionality.…”

Section: Treatmentmentioning

confidence: 99%

“…Patients are usually discharged with an oral Ciprofloxacin along with appropriate antifungal if fungal smears are positive. The widespread use of oral fluoroquinolones along with incomplete treatment course for MOE, has led to increase in reports of resistance [43].…”

Section: Treatmentmentioning

confidence: 99%

“…Use of third generation Cephalosporins with antipseudomonal activity like Cefaperazone has become an alternative in cases of Ciprofloxacin resistance [43]. Combination therapy of Cefaperazone with Sulbactam has been found to be synergistic and effective as Cefaperazone provides a broad gram positive and gram negative coverage, and Sulbactam provides protection from beta-lactamase [41].…”

Section: Treatmentmentioning

confidence: 99%

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Malignant Otitis Externa-A Review

S¹

2014

J Infect Dis Ther

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Objective: To review the literature about Malignant Otitis Externa. Methodology:A comprehensive review of existing knowledge that is available in literature has been summarised in this article.Results: There is a rising incidence of Malignant Otitis Externa in the developing countries, predominantly seen in elderly diabetics. The common organism isolated is Pseudomonas aeruginosa though other microbials have been described as a causative agent. Radioimaging such as Technitium 99m MDP Scintigraphy, Gallium 67 Single Photon Emission CT and Tc99m Sulesomab scan has been recently used to asses and monitor therapy. The treatment protocol involves initial management with intravenous antimicrobials, regular aural toileting with adjunctive Hyperbaric Oxygen therapy. Unresponsive patients require either a trial with antifungals or a tissue diagnosis to rule out other differentials. Surgery is no longer found to be a first line treatment of MOE. Conclusion:Malignant Otitis Externa is a highly fatal, necrotizing condition of the external auditory canal and temporal bone which is seen in elderly immunocompromised individuals. It is a highly aggressive skull base infection that is associated with high morbidity/mortality and cranial nerve complications. Although a variety of organisms such as Proteus mirabilis, Staphylococci, Klebsiella species and Aspergillus fumigatus have been implicated in the pathogenesis of MOE, Pseudomonas aeruginosa has been a predominant organism closely associated with MOE. With the advent of present day radiological imaging and effective antimicrobials coupled with a high index of suspicion, the mortality rate has been reduced from an alarming 50% to 20% over the past few decades.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Malignant Otitis Externa-A Review

S¹

2014

J Infect Dis Ther

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“…Bergholz and assoc. in their study proved that 33% of MOE caused by Pseudomonas bacretia showed high resistency on Ciprofloxacin [10]. Standard laboratory tests include sedimentation rate of erythrocytes, CRP, leukocyte formula, fibrinogen, hematocrit and glucose but all unspecified so these tests have to match the complete diagnostic picture in order for MOE to be adequately diagnosed and treated [9].…”

Section: Discusionmentioning

confidence: 99%

Malignant otitis externa: Variability of clinical course and difficulties of diagnostics

Janicijevic¹

2014

Praxis Med

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This paper shows the case of a 70-year-old diabetic patient who was admitted to the ORL and MFS clinic as an emergency case with the right ear otalgia, in the right mastoid extension, facialis paralysis and the right ear suppuration all of which lasted for a month before the hospitalization. On admission, the innitial diagnostics stated canal skin edema of the external hearing canal which made the eardrum impossible to visualize. Granulations at the bottom of the canal were visible. During the admission, the patient was submitted to conservative and surgical treatments which confirmed that it was the case of malignant otitis externa.

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“…Increasing numbers of ciprofloxacin-resistant Pseudomonas infections means that identifying antibiotic sensitivity remains important. 17 Mortality data in NOE is poorly documented, but fatal events are usually due to intracranial complications such as dural sinus thrombosis, meningitis and intracranial abscesses. 5,9 A recent case series of 46 patients treated for NOE quoted healing rates over 95% after a mean follow-up of around 78 weeks.…”

mentioning

confidence: 99%

Necrotising otitis externa: an unusual cause of cranial nerve palsy in a diabetic haemodialysis patient

Zammit-Maempel²,

Stafford³

et al. 2010

JRCPE

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A 77-year-old South Asian man presented to the acute admissions service with a one-month history of progressive, left-sided facial weakness and left-sided mandibular and pre-auricular pain. A diagnosis of Bell's palsy was made. He was receiving ongoing treatment for ipsilateral otitis externa with topical tri-adcortyl ointment. His medical history included end-stage renal disease (ESRD) of uncertain cause, treated with hospital haemodialysis; poorly controlled insulin-treated type 2 diabetes mellitus; ischaemic heart disease; and gout.Unfortunately, the patient's symptoms continued to deteriorate and he was admitted to renal services from the haemodialysis unit. On examination he had periauricular tenderness and purulent discharge from the left auditory canal and associated conductive hearing loss. There was a left lower motor neurone facial palsy, with grade III upper division involvement and grade IV lower division involvement (House-Brackmann classification).1 Other cranial nerves were spared. Inflammatory markers were mildly elevated with a C-reactive protein of 71 mg/l. Glycosylated haemoglobin (HbA1c) of 10.7% reflected recent poor glycaemic control. Left-sided otoscopy revealed posteroinferior perforations of the tympanic membrane, with debris and mucopurulent discharge on the left, and pure-tone audiometry confirmed conductive deafness. A contrast-enhanced computerised tomography (CT) scan demonstrated soft tissue thickening in the external auditory canal and a 2.7 x 1.3 cm mass below the left skull base, engulfing the carotid artery and severely compressing the internal jugular vein. The mass extended through the parapharyngeal space onto the lateral pterygoid and deep temporalis muscles (Figure 1). Auricular swabs grew Aspergillus flavus and Proteus mirabilis.A diagnosis of necrotising (malignant) otitis externa (NOE) was made. The patient was treated for a total of six weeks with systemic agents and localised intraauricular ribbon gauze. He completed four weeks of intravenous meropenem (1 g once daily), combined with oral ciprofloxacin (250 mg twice daily) and voriconazole (400 mg mane, 200 mg nocte). Thereafter he continued with a further two weeks of oral ciprofloxacin and voriconazole. Doses were adjusted for the renal impairment and haemodialysis requirements. Topical ribbon gauze soaked with amphotericin and nystatin was administered daily over this period. The initial treatment was based upon the likelihood that Pseudomonas is the usual causative agent, and that resistant strains of Pseudomonas are increasingly prevalent. Culture results guided treatment thereafter.Two months later the facial nerve palsy was improving so that the lower division involvement had reduced to grade II weakness. Otoscopy confirmed reduced suppurative discharge with ongoing dry perforation of the tympanic membrane. Follow-up CT scans at three months and then seven months from diagnosis showed continuing improvement (Figure 2). DISCUSSIONThis case highlights a number of key learning points. The ESRD and diabetic populat...

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Evolving Resistant Pseudomonas to Ciprofloxacin in Malignant Otitis Externa

Cited by 99 publications

References 13 publications

Malignant Otitis Externa-A Review

Malignant Otitis Externa-A Review

Malignant otitis externa: Variability of clinical course and difficulties of diagnostics

Necrotising otitis externa: an unusual cause of cranial nerve palsy in a diabetic haemodialysis patient

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