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Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa

Leonard Berenholz1, Udi Katzenell, Moshe Harell

  • 1Department of Otolaryngology, E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel. Leonard@netvision.net.il

The Laryngoscope
|September 28, 2002
PubMed
Abstract

Insights

Ciprofloxacin-resistant Pseudomonas is increasing in malignant otitis externa cases. However, this resistance has not led to increased disease severity or mortality in this study. Further treatment strategies may be needed.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Medical Microbiology

Background:

  • Malignant otitis externa (MOE) is a severe infection typically caused by Pseudomonas aeruginosa.
  • Ciprofloxacin has been a common treatment for MOE, but antibiotic resistance is a growing concern.

Purpose of the Study:

  • To investigate the trend of ciprofloxacin-resistant Pseudomonas in MOE cases.
  • To assess if this resistance impacts the morbidity of MOE.

Main Methods:

  • Retrospective review of 28 patients diagnosed with MOE over 13 years (1988-2001) at a tertiary referral center.
  • Analysis of culture and sensitivity tests for Pseudomonas isolates.

Main Results:

  • Seven out of 28 patients (25%) had ciprofloxacin-resistant Pseudomonas.
  • A significant trend of increasing ciprofloxacin resistance was observed, with 5 resistant cases in the last 3 years versus 2 in the preceding 10 years.
  • No significant difference in morbidity or mortality was found between patients with ciprofloxacin-resistant and ciprofloxacin-sensitive Pseudomonas.

Conclusions:

  • There is an increasing incidence of ciprofloxacin-resistant Pseudomonas in malignant otitis externa.
  • This emerging resistance may necessitate a shift in treatment paradigms.
  • Consideration should be given to intravenous third-generation cephalosporins or antipseudomonal penicillins, alongside more frequent debridement, for resistant cases.

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