Malignant Otitis Externa Resistant to Ciprofloxacin: Implications for Treatment

Background and Aim: With the introduction of ciprofloxacin in the late 1980s, many patients with malignant otitis externa were successfully treated on an outpatient basis. In recent years, there have been an increasing number of patients reported with ciprofloxacin-resistant pseudomonas malignant otitis externa seen in the literature.

Case Report: An 87-year-old man presented at a distdistrict general hospital with severe nocturnal ear pain and characteristic findings of edema, granulations of the external ear canal, and purulent discharge. He had a history of diabetes mellitus. The patient failed to respond after 2 weeks of oral ciprofloxacin. After being admitted to the hospital, he was treated with intravenous antibiotics (ciprofloxacin, ceftazidime, and vancomycin) and local treatment. Progress was monitored by serial ESR, MRIs, CT scans, and isotope bone scans that revealed skull base involvement. After the patient had been hospitalized for 2 months, no significant improvement was noted, and facial palsy was added in the clinical picture; therefore, the patient was transferred to our hospital for further treatment. Carbapenem was added in the conservative management, and this improved the patient's condition (the patient did not have any serious pain). After the patient's condition remained stable during the following month, a radical mastoidectomy was performed.

Conclusion: For 15 years, oral ciprofloxacin has been the standard treatment for malignant otitis externa. Resistance to ciprofloxacin in these patients is increasing over time. New antibiotics should be added in their management, and surgical debridement should be considered in selected cases.