Necrotising otitis externa antibiotic therapy complications: A retrospective cohort analysis

Ijaz, Ali; Williams, Emma J.; Watson, Glen

doi:10.1111/coa.13921

Cited by 3 publications

(7 citation statements)

References 10 publications

(30 reference statements)

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“…Of 196 patients in studies where side effects were reported, the most common were allergy (9 per cent), renal impairment (9 per cent), hepatotoxicity (7 per cent) and leukopenia (6 per cent), with only one published study focusing on the complications of antimicrobial therapy for necrotising otitis externa. 23…”

Section: Resultsmentioning

confidence: 99%

“…Robust, consistent reporting of clinical outcomes is important, and will be facilitated by the publication of a core outcome set for necrotising otitis externa. Whilst consensus processes can be useful in the identification of best practice regarding the initiation, cessation, and modification of treatment, and disease monitoring in the absence of high-level evidence, robust clinical trials are indicated to definitively answer the Ijaz 23 82…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…16 Although challenging to attribute specific antimicrobial regimens due to heterogeneous reporting, it is clear from this review that the side effects of antimicrobial therapy are common and can be serious. 23 Criteria for cessation of treatment were provided by 10 studies. These included variable combinations of disease resolution based on clinical symptoms and examination, imaging and inflammatory markers.…”

Section: Overall Certaintymentioning

confidence: 99%

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A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Lodhi,

Timms,

Stapleton

2023

J. Laryngol. Otol.

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Background Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa. Methods The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (‘PRISMA’) guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed. Results Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes. Conclusion Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Overall Certaintymentioning

confidence: 99%

See 2 more Smart Citations

A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Lodhi,

Timms,

Stapleton

2023

J. Laryngol. Otol.

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“…4 However, in recent years, there has been an increase in cases caused by other pathogens, both bacterial and fungal. 5 Necrotizing otitis externa generally occurs in elderly patients with diabetes, immunosuppression, or other risk factors. 6 Clinically, it is similar to acute external otitis (AEO) and does not present pathognomonic features on physical examination, often leading to a delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

Costa,

Onishi

2023

Int Arch Otorhinolaryngol

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Introduction Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients. Objective To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa. Methods A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020. Results There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease. Conclusions The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.

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Management and Outcomes of Necrotizing Otitis Externa: A Retrospective Cohort Study in a Tertiary Referral Center.

Vosbeek,

Straatman,

Braat

et al. 2023

Otology &Amp; Neurotology Open

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Objectives: Necrotizing otitis externa (NOE) is a rare infection of the ear that causes osteomyelitis. We aimed to evaluate treatment outcomes and the role of imaging in diagnosing and monitoring disease resolution in a single-center study of patients with NOE. Methods: In this retrospective cohort study, patients with NOE who were diagnosed and treated in a tertiary otology center in Utrecht, The Netherlands, between January 1, 2013 and August 1, 2022, were included. Data were retrieved from the medical records on demographics, symptoms, physical and diagnostic findings, type and duration of treatment, and course of disease. Results: A total of 24 cases were included. Patients were often elderly (mean age = 75 years) and diabetic (88%). Pseudomonas aeruginosa was the most commonly found microorganism (63%). Twenty-two cases (92%) received intravenous antibiotic treatment, and 7 cases (29%) received additional systemic antifungal treatment. The mean duration of systemic treatment was 29 weeks. In 20 out of 22 cases (91%), imaging was used to determine the end point of treatment. None of the cases with a total resolution of disease activity (n = 5) on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography imaging at the time of cessation of therapy showed clinical relapse, compared with 1 out of 4 cases on gallium single-photon emission computerized tomography. Conclusion: Based on the experience from our center, we demonstrated that patients with NOE can successfully be treated with prolonged systemic treatment. Molecular imaging is reasonably successful for disease evaluation and decision-making on the eradication of disease.

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Necrotising otitis externa antibiotic therapy complications: A retrospective cohort analysis

Cited by 3 publications

References 10 publications

A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

Management and Outcomes of Necrotizing Otitis Externa: A Retrospective Cohort Study in a Tertiary Referral Center.

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