Ciprofloxacin in the Treatment of Malignant External Otitis

Abstract

Malignant external otitis is a serious infection most frequently caused by Pseudomonas aeruginosa. Because of its antipseu-domonal activity and good tissue penetration, ciprofloxacin is an antibiotic which should, in theory, be effective in the treatment of this type of infection. Publications on the use of ciprofloxacin in the treatment of malignant external otitis are analysed below. This paper analyses 84 clinical case studies collected from 13 publications: ciprofloxacin, administered for the most part orally, was given in a dosage of 750 mg twice daily, apart from three studies where a lower dosage of 500 mg twice daily was used. When the drug was administered parenterally, the dosage was 200 mg b.i.d. In one publication, ciprofloxacin was used in combination with rifampicin. The average duration of treatment was 3 months. Ps. aeruginosa was isolated in 82 patients and sensitivity tests were carried out on 47 strains, none of which was resistant to ciprofloxacin. The clinical cure rate was 96.4% (84 patients). The rate of bacteriological eradication was close to 100% in the 76 evaluable patients. Long-term follow-up (between 2 and 44 months) showed that clinical and bacteriological cure was maintained in all but two patients. Ciprofloxacin thus seems to be a particularly useful antibiotic for the treatment of malignant external otitis, both because of its clinical and bacteriological efficacy and because it is well tolerated.

Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors

“…P. aeruginosa was identified as the causative organism in 65% of the patients, predominantly among diabetics, with atypical non-pseudomonal organisms constituting 24%, predominantly among non-diabetics, similar to other studies (Loh and Loh, 2013;Franco-Vidal et al, 2007). However higher figures of 85 to 95% pseudomonas isolation have been reported (Pulcini et al, 2012;Gehanno, 1994). In contrast to the findings, lower rates of pseudomonas isolation <50% have also been reported (Hobson et al, 2014;Chen et al, 2011).…”

Skull base osteomyelitis: current microbiology and management

“…The management of culture-negative skull base osteomyelitis, now a common clinical entity, has been described, with good outcomes using a combination of intravenous cephalosporin and oral ciprofloxacin 11 . Prolonged and targeted systemic antimicrobial therapy is required: a broad spectrum cephalosporin combined with ciprofloxacin is the treatment of choice, with a high cure rate 17 . Hyperbaric oxygen has been used with some benefit as an adjunct to antimicrobials; 18 however, a Cochrane review found that no randomised, controlled trials had been performed to support this treatment 19 …”

Malignant Otitis Externa-A Review

“…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.…”