Efficacy of Oral Ciprofloxacin Plus Rifampin for Treatment of Malignant External Otitis

Abstract

\s=b\ Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin.The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit.

Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition

“…In contrast to a report in the early necrotising otitis externa literature, 24 our data showed that elevated CRP, not erythrocyte sedimentation rate was significantly associated with complex disease. However, there was a large overlap in CRP values between those with complex and non-complex disease suggesting this assay cannot reliably distinguish one group from the other.…”

Skull base osteomyelitis: Incidence of resistance, morbidity, and treatment strategy

“…The incidence of PACR has increased in recent years. In the 1980s, treatment of SBO was revolutionized by the arrival of ciprofloxacin monotherapy for outpatient treatment . P. aeruginosa resistance to ciprofloxacin emerged in the 1990s and has recently grown, as shown in the series of Berenholz and Loh, which found an incidence of 33% of PACR.…”

Malignant Otitis Externa: An Asian Perspective on Treatment Outcomes and Prognostic Factors

“…Our results suggest that the empirical use of combination anti-pseudomonal therapy with intravenous ceftazidime and oral ciprofloxacin in culture-negative cases remains relevant despite increasing antibiotic resistance in P aeruginosa .This is consistent with reports in the literature. 18,22 Rubin et al 23 proposed the use of combination therapy with oral rifampacin and ciprofloxacin in treating drug-resistant P aeruginosa , and they showed that their oral and intravenous regimes were equally efficacious. However, in another study by Korvick et al 24 involving 121 patients with positive blood cultures for P aeruginosa , no significant benefit was demonstrated from the addition of rifampacin to existing anti-pseudomonal therapy, suggesting that further clinical studies on the anti-pseudomonal properties of rifampacin are needed.…”