What Is the Treatment of Malignant (Necrotising) Otitis Externa?
Malignant otitis externa — also called necrotising otitis externa — requires a structured first-line antibiotic protocol supported by targeted clinical measures, with treatment continuing until full resolution is achieved.
First-Line Treatment Approach
The approach centres on empirical intravenous antibiotic monotherapy combined with topical antibiotic ear drops and a series of supportive care measures tailored to the patient's specific needs, before stepping down to oral antibiotics to complete the treatment course.
Treatment Goals
The protocol targets complete absence of presenting symptoms and signs of ear infection, with clinical resolution of the necrotising infection achieved over the full antibiotic treatment course.
References
DOI: 10.1016/j.jgar.2021.06.015
- Empirical IV Ceftazidime monotherapy antibiotics
- Topical antibiotics were used in all cases either initially or as an add-on therapy.
- Microsuction daily
- Since most NOE patients also suffer from diabetes mellitus and other forms of immunosuppression, their treatment must be optimised with the addition of good glycaemic control and mechanical measures such as microsuction.
- Correction of immunosuppression
- Analgesia
- Post discharge Oral antibiotics, typically Ciprofloxacin for at least 4/52
- 90% of post-discharge oral antibiotics were high-dose ciprofloxacin or dual therapy containing high-dose ciprofloxacin.
- Overall, patients did well on 6–7 weeks of antibiotic therapy.
- Absence of presenting symptoms and signs of infection
- Clinical Resolution of NOE