Ceftazidime monotherapy effective for necrotizing otitis externa, Finds study

Patients who are elderly, diabetic or immunocompromised are at greater risk of NOE. Malignant external otitis is frequently characterized by nuanced and insidious symptomatology.

James Frost and Anda Samson from the Hull York Medical School, John Hughlings Building, University Road, Heslington, York together aimed to produce a NOE treatment protocol from literature and clinical experience.

As a team, a total of 26 case series studies were reviewed in combination with a retrospective case series of inpatients from Hull University Teaching Hospitals Trust. Over 5 years, 40 patients were identified with 29 being analysed due to unavailable or incomplete case notes.

The results of the research revealed that the most common bacteria causing NOE was Pseudomonas aeruginosa. It was also observed that resistance to ciprofloxacin was prevalent; however multidrug resistance was rare.

Furthermore, ciprofloxacin and ceftazidime were the most widely used antibiotics. No ceftazidime resistance was reported in the literature or in the present cohort. The average age of the patients in the cohort was 80 years.

Sixty-two percent had either diabetes or were immunosuppressed. One patient died directly due to NOE related sepsis. Intravenous ceftazidime monotherapy was mostly used. The duration of treatment was 6-7 weeks, with no relapses documented.

As a result, the authors concluded that ceftazidime monotherapy was an effective empirical treatment in our cohort, and a total duration of 6-7 weeks of antibiotics was sufficient.

The authors inferred that they have created a standardized treatment protocol based on the findings which will need to be validated in a larger cohort of patients.