Treatment of Infections of the Ears, Nose, and Throat and Nasal Carriage

Abstract

Despite the widespread use of quinolones to treat infections of the ears, nose, and throat, well-controlled studies are uncommon. Malignant (necrotizing) external otitis is an invasive infection of the external auditory canal and skull base, whose typical host is the elderly patient with diabetes mellitus. With the advent and widespread use of quinolones for all ear infections, patients with malignant external otitis are being diagnosed and treated earlier in the course of the disease, thus changing the clinical spectrum of this infection. Oral ciprofloxacin has been used successfully for individuals with auricular perichondritis. Potential limitations of oral quinolones for the treatment of soft-tissue infections of the auricle are suggested by reports of phototoxic lesions induced by quinolones in the auricular skin of mouse models. Cumulative evidence supports the utility of quinolones for treatment of chronic ear infections with multiresistant bacterial. Infections of the ear, nose, and throat are among the most common outpatient maladies in the world. Oral quinolones are the drugs of choice for the treatment of disease caused by Pseudomonas aeruginosa, including malignant external otitis and auricular perichondritis. Similarly, there appears to be little rationale for the use of quinolones as initial therapy for otitis media, sinusitis, or pharyngotonsillitis. In fact, pneumococcal bacteremia following ciprofloxacin therapy for acute otitis media has been reported.