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Efficacy of Oral Ciprofloxacin Plus Rifampin for Treatment of Malignant External Otitis

Efficacy of Oral Ciprofloxacin Plus Rifampin for Treatment of Malignant External Otitis Abstract • Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin. The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit. (Arch Otolaryngol Head Neck Surg. 1989;115:1063-1069) References 1. Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy . Am J Med. 1988; 85:391-398.Crossref 2. Chandler JR. Malignant external otitis . Laryngoscope. 1968;78:1257-1294.Crossref 3. Chandler JR. Pathogenesis and treatment of facial paralysis due to malignant external otitis . Ann Otol. 1972;81:648-658. 4. Chandler JR. Malignant external otitis and facial paralysis . Otolaryngol Clin North Am. 1974;7:375-383. 5. Chandler JR. Malignant external otitis: further considerations . Ann Otol. 1977;86:417-428. 6. Doroghazi RM, Nadol JB, Hyslop NE, Baker AS, Axelrod L. Invasive external otitis: report of 21 cases and review of the literature . Am J Med. 1981;71:603-614.Crossref 7. Lucente FE, Parisier SC, Som PM. Complications of the treatment of malignant external otitis . Laryngoscope. 1983;93:279-281.Crossref 8. Gold S, Som PM, Lawson W, Lucente FE, Mendelson M, Parisier SC. Radiographic findings in progressive necrotizing 'malignant' external otitis . Laryngoscope. 1984;94:363-366.Crossref 9. Mendelson MH, Meyers BR, Hirschman SZ, Shapiro ER, Parisier SC. Treatment of invasive external otitis with cefsulodin . Rev Infect Dis. 1984;6:s698-s704.Crossref 10. Meyers BR, Mendelson MH, Parisier SC, Hirschman SZ. Malignant external otitis: comparison of monotherapy vs combination therapy . Arch Otolaryngol Head Neck Surg. 1987;113:974-978.Crossref 11. Corey JP, Levandowski RA, Panwalker AP. Prognostic implications of therapy for necrotizing external otitis . Am J Otol. 1985;6:353-358.Crossref 12. Sando I, Harada T, Saito R, Okano Y, Caparosa RH. Temporal bone histopathology of necrotizing external otitis . Ann Otol. 1981;90:109-115. 13. Kim BH. Roentgenographic findings of malignant external otitis . AJR. 1971;112:366-372.Crossref 14. Curtin HD, Wolfe P, May M. Malignant external otitis: CT evaluation . Radiology. 1982; 145:383-388.Crossref 15. Haverkos HW, Caparosa R, Yu VL, Kamerer D. Moxolactam therapy: its use in chronic suppurative otitis media and malignant external otitis . Arch Otolaryngol Head Neck Surg. 1982;108:329-333.Crossref 16. Krol G, Noe AJ, Beerman D. Liquid chromatographic analysis of ciprofloxacin and ciprofloxacin metabolites in body fluids . J Liquid Chromatogr. 1986;9:2897-2919.Crossref 17. Lecaillon JB, Febvre N, Metayer J, Souppart L. Quantitative assay of rifampin and three of its metabolites in human plasma, urine, and saliva by high performance liquid chromatography . J Chromatogr. 1978;145:319-324.Crossref 18. Yu VL, Zuravleff JJ, Bornholm J, Archer G. In vitro synergy testing of triple antibiotic combinations against Staphylococcus epidermidis isolates from patients with endocarditis . J Antimicrob Chemother. 1984;14:359-366.Crossref 19. Holder CD, Gurucharri M, Bartels LJ, Colman MF. Malignant external otitis with optic neuritis . Laryngoscope. 1986;96:1021-1023.Crossref 20. Chakeres DW, Kapila A, LaMasters D. Soft-tissue abnormalities of the external auditory canal: subject review of CT findings . Radiology. 1985;156:105-109.Crossref 21. Rubin J, Curtin HD, Yu VL. The utility of serial CT scans in the diagnosis and follow-up of malignant external otitis. Presented at the American Academy of Otolaryngology–Head and Neck Surgery, Washington, DC, September 1988:358. Abstract. 22. Leese AJ, Freer C, Salata RA, Francis JB, Scheid WM. Oral ciprofloxacin therapy for gram-negative bacillary osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987;82:255-262. 23. Gilbert D, Tice AD, Marsh PK, Craven PC, Preheim LC. Oral ciprofloxacin therapy for chronic contiguous osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987; 82:S254-S258.Crossref 24. Slama TG, Misinski J, Sklar S. Oral ciprofloxacin therapy for osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987; 82:S259-S261. 25. Hessen MT, Ingerman MJ, Kaufman OH, et al. Clinical efficacy of ciprofloxacin therapy for gram-negative bacillary osteomyelitis . Am J Med. 1987;83:S262-S265. 26. Greenberg RN, Tige AD, Marsh PK, et al. Randomized trial of ciprofloxacin compared with other antimicrobial therapy in the treatment of osteomyelitis . Am J Med. 1987;82:S266-S269.Crossref 27. Wise R, Donovan IA. Tissue penetration and metabolism of ciprofloxacin . Am J Med. 1987;82:S103-S107. 28. Schluter G. Ciprofloxacin: review of potential toxicologic effects . Am J Med. 1987;82:S91-S93. 29. Raines JM, Schindler RA. The surgical management of recalcitrant malignant external otitis . Laryngoscope. 1980;90:606-609.Crossref 30. Korvick J, Peacock J, Muder RR, Wheeler R, Yu VL. Addition of rifampin to combination therapy for Pseudomonas aeruginosa bacteremia. In: Interscience Conference Antimicrobial Agents Chemotherapy, New York, NY, 1987:230. Abstract. 31. Yu VL, Zuravleff J, Peacock J, Dehertogh D, Tashjian L. Addition of rifampin to carboxypenicillin-aminoglycoside combination for the treatment of P aeruginosa infection: clinical experience with four patients . Antimicrob Agents Chemother. 1984;26:575-577.Crossref 32. Henry NK, Rouse MS, Whitesell AL, McConnell ME, Wilson WK. Treatment of methicillin-resistant Staphylococcus aureus experimental osteomyelitis with ciprofloxacin or vancomycin alone or in combination with rifampin . Am J Med. 1987;82:S73-S75. 33. Leggett J, Prendergast K. Malignant external otitis: the use of oral ciprofloxacin . J Laryngol Otol. 1988;102:53-54.Crossref 34. Joachims H, Danino J, Raz R. Malignant external otitis: treatment with fluoroquinolones . Am J Otolaryngol. 1988;9:102-105.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Efficacy of Oral Ciprofloxacin Plus Rifampin for Treatment of Malignant External Otitis

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1989.01860330053016
Publisher site
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Abstract

Abstract • Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin. The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit. (Arch Otolaryngol Head Neck Surg. 1989;115:1063-1069) References 1. Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy . Am J Med. 1988; 85:391-398.Crossref 2. Chandler JR. Malignant external otitis . Laryngoscope. 1968;78:1257-1294.Crossref 3. Chandler JR. Pathogenesis and treatment of facial paralysis due to malignant external otitis . Ann Otol. 1972;81:648-658. 4. Chandler JR. Malignant external otitis and facial paralysis . Otolaryngol Clin North Am. 1974;7:375-383. 5. Chandler JR. Malignant external otitis: further considerations . Ann Otol. 1977;86:417-428. 6. Doroghazi RM, Nadol JB, Hyslop NE, Baker AS, Axelrod L. Invasive external otitis: report of 21 cases and review of the literature . Am J Med. 1981;71:603-614.Crossref 7. Lucente FE, Parisier SC, Som PM. Complications of the treatment of malignant external otitis . Laryngoscope. 1983;93:279-281.Crossref 8. Gold S, Som PM, Lawson W, Lucente FE, Mendelson M, Parisier SC. Radiographic findings in progressive necrotizing 'malignant' external otitis . Laryngoscope. 1984;94:363-366.Crossref 9. Mendelson MH, Meyers BR, Hirschman SZ, Shapiro ER, Parisier SC. Treatment of invasive external otitis with cefsulodin . Rev Infect Dis. 1984;6:s698-s704.Crossref 10. Meyers BR, Mendelson MH, Parisier SC, Hirschman SZ. Malignant external otitis: comparison of monotherapy vs combination therapy . Arch Otolaryngol Head Neck Surg. 1987;113:974-978.Crossref 11. Corey JP, Levandowski RA, Panwalker AP. Prognostic implications of therapy for necrotizing external otitis . Am J Otol. 1985;6:353-358.Crossref 12. Sando I, Harada T, Saito R, Okano Y, Caparosa RH. Temporal bone histopathology of necrotizing external otitis . Ann Otol. 1981;90:109-115. 13. Kim BH. Roentgenographic findings of malignant external otitis . AJR. 1971;112:366-372.Crossref 14. Curtin HD, Wolfe P, May M. Malignant external otitis: CT evaluation . Radiology. 1982; 145:383-388.Crossref 15. Haverkos HW, Caparosa R, Yu VL, Kamerer D. Moxolactam therapy: its use in chronic suppurative otitis media and malignant external otitis . Arch Otolaryngol Head Neck Surg. 1982;108:329-333.Crossref 16. Krol G, Noe AJ, Beerman D. Liquid chromatographic analysis of ciprofloxacin and ciprofloxacin metabolites in body fluids . J Liquid Chromatogr. 1986;9:2897-2919.Crossref 17. Lecaillon JB, Febvre N, Metayer J, Souppart L. Quantitative assay of rifampin and three of its metabolites in human plasma, urine, and saliva by high performance liquid chromatography . J Chromatogr. 1978;145:319-324.Crossref 18. Yu VL, Zuravleff JJ, Bornholm J, Archer G. In vitro synergy testing of triple antibiotic combinations against Staphylococcus epidermidis isolates from patients with endocarditis . J Antimicrob Chemother. 1984;14:359-366.Crossref 19. Holder CD, Gurucharri M, Bartels LJ, Colman MF. Malignant external otitis with optic neuritis . Laryngoscope. 1986;96:1021-1023.Crossref 20. Chakeres DW, Kapila A, LaMasters D. Soft-tissue abnormalities of the external auditory canal: subject review of CT findings . Radiology. 1985;156:105-109.Crossref 21. Rubin J, Curtin HD, Yu VL. The utility of serial CT scans in the diagnosis and follow-up of malignant external otitis. Presented at the American Academy of Otolaryngology–Head and Neck Surgery, Washington, DC, September 1988:358. Abstract. 22. Leese AJ, Freer C, Salata RA, Francis JB, Scheid WM. Oral ciprofloxacin therapy for gram-negative bacillary osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987;82:255-262. 23. Gilbert D, Tice AD, Marsh PK, Craven PC, Preheim LC. Oral ciprofloxacin therapy for chronic contiguous osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987; 82:S254-S258.Crossref 24. Slama TG, Misinski J, Sklar S. Oral ciprofloxacin therapy for osteomyelitis caused by aerobic gram-negative bacilli . Am J Med. 1987; 82:S259-S261. 25. Hessen MT, Ingerman MJ, Kaufman OH, et al. Clinical efficacy of ciprofloxacin therapy for gram-negative bacillary osteomyelitis . Am J Med. 1987;83:S262-S265. 26. Greenberg RN, Tige AD, Marsh PK, et al. Randomized trial of ciprofloxacin compared with other antimicrobial therapy in the treatment of osteomyelitis . Am J Med. 1987;82:S266-S269.Crossref 27. Wise R, Donovan IA. Tissue penetration and metabolism of ciprofloxacin . Am J Med. 1987;82:S103-S107. 28. Schluter G. Ciprofloxacin: review of potential toxicologic effects . Am J Med. 1987;82:S91-S93. 29. Raines JM, Schindler RA. The surgical management of recalcitrant malignant external otitis . Laryngoscope. 1980;90:606-609.Crossref 30. Korvick J, Peacock J, Muder RR, Wheeler R, Yu VL. Addition of rifampin to combination therapy for Pseudomonas aeruginosa bacteremia. In: Interscience Conference Antimicrobial Agents Chemotherapy, New York, NY, 1987:230. Abstract. 31. Yu VL, Zuravleff J, Peacock J, Dehertogh D, Tashjian L. Addition of rifampin to carboxypenicillin-aminoglycoside combination for the treatment of P aeruginosa infection: clinical experience with four patients . Antimicrob Agents Chemother. 1984;26:575-577.Crossref 32. Henry NK, Rouse MS, Whitesell AL, McConnell ME, Wilson WK. Treatment of methicillin-resistant Staphylococcus aureus experimental osteomyelitis with ciprofloxacin or vancomycin alone or in combination with rifampin . Am J Med. 1987;82:S73-S75. 33. Leggett J, Prendergast K. Malignant external otitis: the use of oral ciprofloxacin . J Laryngol Otol. 1988;102:53-54.Crossref 34. Joachims H, Danino J, Raz R. Malignant external otitis: treatment with fluoroquinolones . Am J Otolaryngol. 1988;9:102-105.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Sep 1, 1989

References