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Use of quinolones for treatment of ear and eye infections
1Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
Abstract:
Malignant otitis externa is a severe, necrotizing infection of the external auditory canal which is sometimes fatal. The traditional antimicrobial treatment has usually been the combination of an antipseudomonal beta-lactam and an aminoglycoside, given intravenously for 4 to 8 weeks. Over 100 patients have been treated with a fluoroquinolone alone, most commonly ciprofloxacin given by mouth in a dosage of 750 mg b.i.d. for 6 to 12 weeks. About 90% of patients have been cured. Treatment with a quinolone has the advantage over older treatments that it can be given orally and has a low rate of side-effects. The ocular penetration of the fluoroquinolones has been studied in patients with unifected eyes. After the administration of a single dose of ciprofloxacin, pefloxacin, ofloxacin or norfloxacin, penetration into the aqueous humor, expressed as the ratio of the peak concentration in the aqueous humor to that in the serum, is about 20%. The penetration of ciprofloxacin into the vitreous humor, based primarily on the data from one report, is about 20%. The concentrations are likely to be higher after repeated doses or in the inflamed eye. Whether the concentrations achieved will be adequate for therapeutic or prophylactic purposes has not been determined.
Insights
Oral fluoroquinolones, like ciprofloxacin, offer a highly effective and safe treatment for malignant otitis externa, achieving a 90% cure rate. This oral therapy presents a significant advantage over traditional intravenous antibiotics.
Area of Science:
- Infectious Diseases
- Pharmacology
- Ophthalmology
Background:
- Malignant otitis externa (MOE) is a severe, necrotizing infection of the external auditory canal.
- Traditional treatment involves intravenous antipseudomonal beta-lactams and aminoglycosides for 4-8 weeks.
Purpose of the Study:
- To evaluate the efficacy and safety of fluoroquinolones as a primary treatment for malignant otitis externa.
- To assess the ocular penetration of fluoroquinolones.
Main Methods:
- Over 100 patients with MOE were treated with oral fluoroquinolones (primarily ciprofloxacin 750 mg b.i.d. for 6-12 weeks).
- Ocular penetration of ciprofloxacin, pefloxacin, ofloxacin, and norfloxacin was studied in patients with uninfected eyes after a single dose.
Main Results:
- Approximately 90% of patients treated with oral fluoroquinolones achieved a cure.
- Fluoroquinolone treatment demonstrated a low rate of side-effects compared to older therapies.
- Ocular penetration into aqueous and vitreous humor was approximately 20% after a single dose, potentially higher with repeated doses or inflammation.
Conclusions:
- Oral fluoroquinolones represent a safe and effective monotherapy for malignant otitis externa.
- Further research is needed to determine if achieved ocular concentrations are therapeutic for ocular infections.