علاج التهاب الأذن الخارجية في المرضى المصابين بالسكري أو حالات نقص المناعة أو فيروس نقص المناعة البشرية — أو عند امتداد العدوى خارج قناة الأذن

References

DOI: 10.1177/0194599813517083

• Clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy.
• The key components of the clinical history that can modify management of diffuse AOE include (1) diabetes; (2) HIV infection, AIDS, or other immunocompromised states, such as patients with malignancies receiving chemotherapy; (3) history of radiotherapy; and (4) presence of tympanostomy tubes or perforated tympanic membrane (nonintact tympanic membrane).
• The clinician should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain.
• Topical therapy should be supplemented by systemic antibiotics if the affected individual has a condition, especially diabetes, that is associated with markedly increased morbidity, or HIV infection/AIDS with immune deficiency, that could impair host defenses; if the infection has spread beyond the confines of the ear canal into the pinna, skin of the neck or face, or into deeper tissues such as occurs with malignant external otitis; or if there is good reason to believe that topical therapy cannot be delivered effectively.
• Systemic antibiotics, if indicated, should include coverage for common AOE pathogens, including P aeruginosa and S aureus.
• Appropriate treatment of uncomplicated AOE should be followed by symptom improvement (otalgia, itching, fullness) within 48 to 72 hours, although symptom resolution may take up to 2 weeks.