Relapsing malignant otitis externa successfully treated with ciprofloxacin

Two cases are presented, both patients with advanced relapsing malignant otitis externa. The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b.d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.