Is Multidrug Resistance in Acute Otitis Media with Streptococcus pneumoniae Associated with a More Severe Disease?

OBJECTIVES: Streptococcus pneumoniae is the leading bacterial etiologic agent in acute otitis media (AOM), and it produces a more severe inflammatory response than other otopathogens. Additionally, the presence of multidrug-resistant (MDR) S. pneumoniae is an important issue in the management of AOM. The present pilot study aimed to ascertain whether MDR S. pneumoniae is associated with a higher inflammatory response and/or a more severe disease. METHODS: This was a prospective, single-center study on nonpneumococcal conjugate vaccine-immunized pediatric patients with severe AOM. Demographic and clinical characteristics were recorded. Middle ear fluid was obtained and cultured for each patient; antibiotic-resistance profiling was tested for S. pneumoniae isolates. The C-reactive protein (CRP) level and complete blood count were determined. Patients with positive middle ear fluid culture for S. pneumoniae were divided into 2 groups according to antibiotic resistance profile: MDR and non-MDR. RESULTS: MDR S. pneumoniae was identified in 15 (35.7%) of the 42 eligible patients. Children in this group had significantly higher CRP levels (72.23 ± 62.92 vs. 14.96 ± 15.57 mg/L, p < 0.001), higher absolute neutrophil count (8.46 ± 3.97 vs. 5.22 ± 4.5 × 103/mm3, p = 0.004), higher percentage of neutrophils (52.85 ± 13.49% vs. 38.34 ± 16.16%, p = 0.004), and were more prone to develop acute mastoiditis (p = 0.01). Receiver operating characteristic analysis identified CRP as the best biomarker to discriminate between the 2 groups of patients (AUC = 0.891). CONCLUSION: MDR S. pneumoniae was associated with a more severe inflammatory response and a higher incidence of mastoiditis.

Treatment of chronically infected open mastoid cavities with medical honey: a randomized controlled trial.

OBJECTIVE: To investigate the efficacy of medical honey as topical treatment of chronically discharging open mastoid cavities in comparison with conventional eardrops. STUDY DESIGN: Single-center, prospective, randomized controlled, double-dose trial of 12 weeks. PATIENTS AND INTERVENTION: Twenty-eight patients diagnosed as having a chronically discharging open mastoid cavity underwent medical honey gel (intervention) or conventional eardrops (control) treatment. Treatment interventions were repeated after 4 weeks. MAIN OUTCOME MEASURES: Visual analogue scale of ear complaints, cavity inflammation, and bacterial infection. RESULTS: Most patients had a cavity with localized granulation. After treatment, inflammation score decreased in both groups (p < 0.05), with more pronounced inflammation-free cavities in the honey group. Honey treatment resulted in less discomfort (p < 0.001) and otorrhea (p < 0.001), even after correction for additional medication use (p < 0.05, p < 0.01). This decrease was not seen in the control group. Pain and itching did not change on treatment. Most cavities were infected with Pseudomonas species and Staphylococcus aureus. After treatment, a 23% increase of negative culture was seen with honey compared with 30% in the control group (nonsignificant). No serious adverse reactions were found. CONCLUSION: Medical honey gel is a safe alternative treatment option for patients with a chronically discharging open mastoid cavity and beneficial in reducing discomfort, otorrhea, and inflammation with a bactericidal effect.

Acute coalescent mastoiditis caused by antibiotic resistant organisms.

Two cases of acute coalescent mastoiditis with subperiosteal abscess are presented. Cultures from both abscesses resulted in bacteria resistant to commonly prescribed oral antibiotics. Historical perspectives on acute mastoiditis as well as the emergence of multi-drug resistant bacteria will be discussed. Current diagnostic evaluation and effective therapy for acute mastoiditis will also be reviewed.

[Local antibiotic therapy of bacterial ear infections]. / Antibiotische Lokaltherapie bakterieller Ohrinfektionen.

Local antibiotic treatment in bacteriological infections of outer or inner surfaces is more effective and less expensive than the systemic antibiotic therapy. In the ear local application of an antibiotic may be indicated in bacterial external otitis, in the suppurating radical cavity and perioperatively in chronic otitis media. - After a short survey on suitable antibiotics a study is presented, using the 0.2% solution of Ciprofloxacine for local application in bacterial external otitis (n = 34), infected radical cavities (n = 31) and external otitis complicating a chronic middle ear disease (n = 5). Dry ears, as a whole, resulted in 86%. These results were distinctly better than those obtained with systemic Ciprofloxacine treatment (63%). In pseudomastoiditis or complicating lymphadenitis a combined local and systemic Ciprofloxacine therapy was successful (n = 7). No adverse reactions were seen. - Local antibiotic treatment in the ear should be performed by the otologist, but not by the general practitioner or even the patient himself.

Ciprofloxacin for the treatment of chronic ear disease.

The treatment of chronic ear disease is often difficult and frustrating. Patients typically present with a history of chronic, persistent otorrhea that has failed to respond to multiple topical and oral antibiotics. Organisms that are resistant to multiple antibiotics are common. Ciprofloxacin has been shown to be effective against a wide range of gram-negative and gram-positive organisms. To evaluate the role of ciprofloxacin in the treatment of chronic ear disease, 21 patients who failed routine therapy for chronic ear disease were prospectively treated with oral ciprofloxacin. Prior to therapy, all ear cultures grew Pseudomonas aeruginosa, Staphylococcus aureus or other gram-negative organisms. Ninety-five percent of patients completing therapy showed either improvement or cure. Only one patient failed to improve. Ciprofloxacin has been shown to be effective in the management of chronic ear disease.

The use of fluoroquinolones in chronic otitis suppurativa.

The present review covers fluoroquinolone usage in chronic otitis suppurativa (COS) in case of chronic otitis media, cholesteatoma, radical mastoid cavity infection and chronic or relapsing otitis externa. A total of six publications were included in the final evaluation. Enoxacin was effective in 35%; ciprofloxacin (five publications) was used in 82 patients with 67% effectivity in otitis externa and otitis media and 61% effectivity in radical mastoid cavity infection. No serious adverse reactions were reported. The promising efficacy of otitis media and otitis externa and safety profile needs further confirmation in double blind prospective clinical studies, that will provide a firm basis for changing the current treatment schedules of COS.

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children]. / Place de l'azlocilline dans le traitement des otites à pyocyanique de l'enfant.

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

[Fosfomycin--a new antibiotic in rhinootolaryngology]. / Fosfomycin--Ein neuartiges Antibiotikum in der HNO-Heilkunde.

Fosfomycin is a relatively new antibiotic drug, deriving from streptomyces species. Its special chemical structure and small molecular size provide a very good diffusion into tissues like bone, fascia and wound exudates as well. In a clinical study Fosfomycin was given to 26 patients with infections mainly of the middle ear and mastoid as well as other ENT-infections. Clinical success, laboratory investigations and bacteriology are described in detail. The drug proved to be of special value in the treatment of chronic purulent otitis, purulent or chronic secreting tympanoplasties or other postoperative middle-ear affections when caused by penicillin-resistant staphylococci, proteus-species and pseudomonas aeruginosa. In the other cases treatment results were good corresponding to the bactericidal spectrum of Fosfomycin. There was one treatment failure in our series, but no reverse reaction at all.