Optimizing Necrotizing Otitis Externa Management: The Role of PET-CT in Antibiotic Stewardship

Area of Science:

• Infectious Diseases
• Nuclear Medicine
• Otolaryngology

Background:

• Necrotizing otitis externa (NOE) and skull base osteomyelitis (SBO) require prolonged antibiotic therapy.
• Optimizing antibiotic regimens and monitoring treatment response are critical for effective management.

Purpose of the Study:

• To optimize antibiotic regimens for NOE and SBO.
• To evaluate the role of positron emission tomography-computed tomography (PET-CT) in monitoring disease progression and guiding treatment cessation.

Main Methods:

• A 2-cycle quality improvement project compared traditional imaging (CT/MRI) with PET-CT-guided management.
• Patients with NOE were retrospectively reviewed (CT/MRI cohort) and prospectively assessed (PET-CT cohort).
• A revised management pathway incorporated PET-CT for treatment response assessment, standardizing oral ciprofloxacin regimens to higher-dose, shorter-duration therapy.

Main Results:

• The PET-CT cohort received significantly shorter ciprofloxacin courses (median 8 vs. 40 weeks, P <0.001) without increased relapse rates.
• PET-CT confirmed resolution in 64% of cases, enabling antibiotic discontinuation.
• Relapses were absent in the PET-CT group, unlike the CT/MRI cohort (P =0.11), with comparable mortality rates.

Conclusions:

• PET-CT effectively guided treatment cessation, reducing antibiotic exposure and duration.
• A higher-dose, shorter-duration ciprofloxacin regimen is safe and effective for NOE/SBO.
• PET-CT is a valuable tool for optimizing antibiotic stewardship in NOE/SBO management.