Failure of Fluorescence to Reveal Middle Ear Penetration of Quinolone Drops

Whitaker, Graham T.; Collins, William O.; Antonelli, Patrick J.

doi:10.1001/archoto.2011.205

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…Unfortunately, prior studies have been unsuccessful in quantifying middle ear penetration from ototopical therapy. 31 One flaw in the replicability of such studies is that access to the middle ear is variable depending on the status of the tympanic membrane (TM). For instance, a small TM perforation, a subtotal perforation, short-arm pressure-equalizing tubes, and long-arm pressure-equalizing tubes all have variable capacities to act as conduits to the middle ear space.…”

Section: Discussionmentioning

confidence: 99%

“…Additional complicating factors warrant consideration, including middle ear and mastoid drug penetration, and a dilution effect by middle ear secretions. Unfortunately, prior studies have been unsuccessful in quantifying middle ear penetration from ototopical therapy 31 . One flaw in the replicability of such studies is that access to the middle ear is variable depending on the status of the tympanic membrane (TM).…”

Section: Discussionmentioning

confidence: 99%

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In Vitro Susceptibility of Ciprofloxacin‐Resistant Methicillin‐Resistant Staphylococcus aureus to Ototopical Therapy

Walker

David

Catalano

et al. 2018

Otolaryngol.--head neck surg.

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Objective Despite the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) otologic infections, choice of treatment remains controversial. Only fluoroquinolone-containing ototopical preparations are approved by the US Food and Drug Administration for middle ear application. Furthermore, American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines advocate ototopical monotherapy for both tympanostomy tube otorrhea and acute otitis externa. Unfortunately, MRSA may be ciprofloxacin resistant. This causes confusion regarding antibiotic selection, because susceptibility profiles reflect a minimum inhibitory concentration (MIC), referenced against systemic, not ototopical, drug delivery dosing. The goal of this study is to determine the ciprofloxacin MIC for ciprofloxacin-resistant MRSA isolates from otologic infections and compare that value to the expected drug concentration achieved by fluoroquinolone ear drops and determine MRSA genotype for each isolate. Study Design In vitro assay with retrospective medical record review. Setting Tertiary care university hospital. Subjects and Methods Thirty otologically sourced ciprofloxacin-resistant MRSA isolates collected from adult and pediatric patients. MICs were calculated by broth dilution method. Isolates underwent multilocus sequence typing and polymerase chain reaction for arcA and Panton-Valentine leukocidin to establish the genotype. Results MICs ranged from 16 to 1025 µg/mL. There was a relationship between MIC and genotype; of the 7 isolates with an MIC value greater than 512 µg/mL, 6 were sequence type (ST)8. Conclusion These findings support the practice of ototopical monotherapy for patients with uncomplicated ciprofloxacin-resistant MRSA otitis externa. However, they raise concern that ototopical therapy may not be adequate to treat highly resistant strains of MRSA infecting the middle ear space.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In Vitro Susceptibility of Ciprofloxacin‐Resistant Methicillin‐Resistant Staphylococcus aureus to Ototopical Therapy

Walker

David

Catalano

et al. 2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate

Solis,

Young,

Velazquez-Castro

et al. 2024

The Cleft Palate Craniofacial Journal

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Objective To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. Design Retrospective cohort study. Setting Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. Patients Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017–2021. Main outcome measures Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea. Results Of the 886 children with tympanostomy tubes placed between 2017–2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant ( MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance. Conclusions Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.

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Failure of Fluorescence to Reveal Middle Ear Penetration of Quinolone Drops

Abstract: Fluorescence is not a satisfactory method of assessing quinolone ED penetration through TTs and TM perforations, the middle ear, and into the nasopharynx.

Cited by 2 publications

References 15 publications

In Vitro Susceptibility of Ciprofloxacin‐Resistant Methicillin‐Resistant Staphylococcus aureus to Ototopical Therapy

In Vitro Susceptibility of Ciprofloxacin‐Resistant Methicillin‐Resistant Staphylococcus aureus to Ototopical Therapy

Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate

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