Treatment of culture-negative skull base osteomyelitis.

OBJECTIVE

To evaluate the efficacy of a therapeutic regimen in the treatment of patients with culture-negative skull base osteomyelitis.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral hospital.

PATIENTS

Eight patients with diabetes mellitus presented with otalgia and were found to have positive technetium and gallium scans of the temporal bone. These patients, however, all had negative cultures of their external auditory canals. All patients had been treated with ototopic drops and two patients had undergone a 2-week course of oral quinolones.

INTERVENTIONS

All patients were treated with a 6-week course of intravenous ceftazidime or aztreonam for penicillin-allergic patients, oral ciprofloxacin at a higher dose than normal, and topical aminoglycoside steroid drops.

MAIN OUTCOME MEASURES

Resolution of the temporal bone gallium scan abnormality, recurrence rate, and time to discharge from the hospital.

RESULTS

The patients were discharged from the hospital within 4 days from admission. All patients showed resolution of the temporal bone abnormality on the gallium scan at the 6-week time point. The median follow-up period was 6 months, and none of the patients had a recurrence of the infection.

CONCLUSION

The above-described treatment regimen will result in a high cure rate and a short hospitalization period.