Saturday, December 21, 2019

Malignant Otitis Externa- Managment Discussion.

Dr. Shakuntala Ghosh: Would be happy if anyone shares a fool-proof
complete treatment schedule for an elderly diabetic with possible
malignant Otitis Externa. He has granulation floor of EAC wth pus,
moderate pain, culture report Pseudomonas sensitive to Pipericillin' tazo?
Cefoperazone- sultamicin.
He has taken the latter combo for 7 days. I have ordered a Ct Mastoids
Duration of symptoms 2 months, treated outside

Dr. Kvss Sastry: Peptaz 10 days
4.5 GM TID 10 days
Please look into fungi also
Aftèr CT temporal bone

Dr. Kiranbir Singh: Ceftazidime 1 gm bd for 10 days. Followed by
Moxifloxacin 400 od for two weeks.
All u need to see response and accordingly change the regime .

Dr. Aru Handa: Most often need to continue antibiotic for weeks or
months even beyond pain and local inflammation  relief.

Dr. Anandabrata Bose: Agree completely and strict control of diabetes

Dr. Madhusudan Rao: My experience Shakunthala,
Inj. Ceftazadime 1gm twice a day
Tab. Ciprofloxacin 500 mg thrice or iv Ciprofloxacin
Topical Ciplox drops hourly for a minimum of 7 days
Followed by
Ciprofloxacin for one month.
As Sastry suggested fungal???
If you can keep ciprofloxacin ointment with dexa as cotton wick will do
wonders twice daily

Dr. Shakuntala Ghosh: Thank u Sir but the aural swab culture showed
Pseudomonas resistant to all
Quinolones.

Dr. Madhusudan Rao: Still it works on long run with higher doses.
Sometimes tge culture test may be
false positive or negative.
Qunalones resistance is a very rare phenomenon. May be false negative

Dr. Amar Singh (Muscat)
Sharing our huge experience of treating Malignant Otitis Externa(MOE) in over
250 patients in diabetic pt successfully in a single institution with  a well defined
Al Nahdha management protocol which is a now a national protocol in Oman followed by all institutions. Hope this helps Dr. Shakunthala and others. Treat this sinister condition in bits and pieces carries high morbidity and morbidity.
Dr.Amar Singh
Senior Consultant 
ENT Al Nahdha Hospital,
Muscat,Oman.

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