Microbial aetiology of otitis externa

Dibb, William L.

doi:10.1016/s0163-4453(05)80004-0

Cited by 40 publications

(36 citation statements)

References 10 publications

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“…19 Despite the well-demonstrated safety and efficacy of topical preparations for treating AOE, about 20% to 40% of subjects with AOE nonetheless receive oral antibiotics, often in addition to topical antimicrobials. 3,16,18 Despite a strong recommendation against the use of systemic (oral or parenteral) antibiotics in the initial guideline, clinicians actually prescribed more systemic antibiotics postpublication (31% vs 22%). 113 Many of the oral antibiotics selected are inactive against P aeruginosa and S aureus, the most common pathogens identified in cases of AOE.…”

Section: Efficacy Of Topical Therapymentioning

confidence: 99%

“…Further, treatment with penicillins, macrolides, or cephalosporins increases disease persistence (rate ratios 1.56 to 1.91), and treatment with cephalosporins also increases recurrence (rate ratio 1.28; 95% CI, 1.03 to 1.58). 3 …”

Section: Efficacy Of Topical Therapymentioning

confidence: 99%

“…12 Nonetheless, about 20% to 40% of patients with AOE receive oral antibiotics, with or without concurrent topical therapy. 3,13,14 The oral antibiotics selected are usually inactive against P aeruginosa and S aureus, may have undesirable side effects, and, because they are widely distributed throughout the body, serve to select out resistant organisms. 15,16 Bacterial resistance is likely of far less concern with topical antimicrobials because the high local concentration of drug in the ear canal will generally eradicate all susceptible organisms plus those resistant to systemically administered antibiotics (which only achieve concentrations at the site of infection several magnitudes lower than when topically administered).…”

mentioning

confidence: 99%

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Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

133

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Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

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Section: Efficacy Of Topical Therapymentioning

confidence: 99%

Section: Efficacy Of Topical Therapymentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

133

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“…S. aureus accounted for 13% of the pathogens isolated from adults and was only slightly lower for children at 10%. The next most common pathogens were Enterococcus, Proteus, Enterobacter, and Klebsiella species [31].…”

Section: Pathogenesismentioning

confidence: 99%

“…Fungal external otitis appears to be relatively uncommon [12,30,31]. Singer et al [13] showed that only Aspergillus and Candida were recovered more frequently from infected ears than from uninfected ears.…”

Section: Pathogenesismentioning

confidence: 99%

External otitis: A challenge in management

Roland

2000

Curr Infect Dis Rep

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The bacterial cause of external otitis was first identified during World War II, and our understanding of this condition and its management has been relatively static until recently. The use of fluoroquinolones to treat pseudomonas infections has focused attention on topical therapy for external otitis and single-drug oral therapy for skull-base osteomyelitis, which arises as a complication of external otitis. This article reviews the pathophysiology of external otitis, outlines management options with special attention to topical therapy, and presents management options for skull-base osteomyelitis.

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