Ciprofloxacin in the treatment of malignant external otitis.

Malignant external otitis is a serious infection most frequently caused by Pseudomonas aeruginosa. Because of its antipseudomonal activity and good tissue penetration, ciprofloxacin is an antibiotic which should, in theory, be effective in the treatment of this type of infection. Publications on the use of ciprofloxacin in the treatment of malignant external otitis are analysed below. This paper analyses 84 clinical case studies collected from 13 publications: ciprofloxacin, administered for the most part orally, was given in a dosage of 750 mg twice daily, apart from three studies where a lower dosage of 500 mg twice daily was used. When the drug was administered parenterally, the dosage was 200 mg b.i.d. In one publication, ciprofloxacin was used in combination with rifampicin. The average duration of treatment was 3 months. Ps. aeruginosa was isolated in 82 patients and sensitivity tests were carried out on 47 strains, none of which was resistant to ciprofloxacin. The clinical cure rate was 96.4% (84 patients). The rate of bacteriological eradication was close to 100% in the 76 evaluable patients. Long-term follow-up (between 2 and 44 months) showed that clinical and bacteriological cure was maintained in all but two patients. Ciprofloxacin thus seems to be a particularly useful antibiotic for the treatment of malignant external otitis, both because of its clinical and bacteriological efficacy and because it is well tolerated.