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PubMed2003

Topical ofloxacin for chronic suppurative otitis media and acute exacerbation of chronic otitis media: optimum duration of treatment.

OBJECTIVE: To assess the optimum duration of topical ofloxacin therapy for chronic otitis media and to compare the response between patients with chronic suppurative otitis media (CSOM) and acute exacerbation of chronic otitis media (AE). STUDY DESIGN: Prospective observational study. SETTING: Five university hospitals and 30 affiliated institutions. PATIENTS: A total of 294 patients who presented to the participating institutions with CSOM were enrolled. Among them, 268 patients were evaluable for safety and 237 were evaluable for efficacy (64 with CSOM and 173 with AE . INTERVENTION: Ofloxacin otic solution was administered for as long as 4 weeks. MAIN OUTCOME MEASURES: Clinical and bacteriologic assessment was done weekly during the treatment period. The clinical response was assessed on the basis of the symptom scores. RESULTS: There were no differences between CSOM and AE patients with respect to sex, age, and severity. The most common bacterial isolate from middle ear discharge was Staphylococcus aureus. The clinical response rates in patients with CSOM and AE were 39.1% and 61.3% after 2 weeks of treatment and 57.8% and 75.1% after 4 weeks, respectively, and the bacterial eradication rate was 91.0% at 2 weeks and 94.6% at 4 weeks. Detection of new fungal infection did not increase as the duration of therapy was prolonged. No serious adverse events were reported. CONCLUSIONS: The duration of treatment was shorter and the clinical response was higher in AE patients than in CSOM patients. The standard topical ofloxacin regimen for chronic otitis media should consist of a 2-week course from the aspect of bacteriologic efficacy, although patients showing insufficient symptomatic improvement after 2 weeks may benefit from another 1 or 2 weeks of therapy. Administration of this drug for as long as 4 weeks can increase the clinical efficacy without causing safety problems.

Acute Disease↗
PubMed2005

Mucosal biofilm formation on middle-ear mucosa in a nonhuman primate model of chronic suppurative otitis media.

BACKGROUND: An increased awareness of bacterial biofilms and their formation has led to a better understanding of bacterial infections that occur in the middle ear. Perhaps the best studied pathogen for its propensity toward biofilm formation is Pseudomonas aeruginosa, also the primary pathogen in chronic suppurative otitis media (CSOM). OBJECTIVE: The aim of this study was to determine whether P. aeruginosa forms a biofilm in the middle ear in the setting of CSOM in a nonhuman primate model. METHODS: Cynomolgus monkeys underwent perforation of the tympanic membrane and inoculation of the middle ear with a known biofilm-forming strain of P. aeruginosa. The contralateral ear was used as an internal control and was neither perforated nor infected. At the end of the study period, both ears were irrigated to remove planktonic bacteria, and the middle ear mucosa was removed and examined ultrastructurally using scanning electron microscopy (SEM) for determination of the presence or absence of biofilm formation. MAIN OUTCOME MEASURE: The identification of middle ear biofilm containing rod-shaped bacteria. RESULTS: SEM revealed that P. aeruginosa formed bacterial biofilm in vivo on the middle ear mucosal surface, seen only in the infected ear. Interestingly, biofilm formation caused by cocci was also seen in both the experimental as well as the control ear. CONCLUSION: P. aeruginosa forms biofilms in the middle ear in CSOM in primates. To our knowledge, this is the first report of disease-associated bacterial biofilm in a nonhuman primate model of CSOM. Such a model lays a foundation for much needed study into the role of biofilms in the pathophysiology of CSOM. Should CSOM be caused by biofilms, which is uncertain at this time, development of novel strategies for treatment and prevention may be possible. The finding of both rods and cocci forming biofilms also warrants further investigation.

Animals↗
PubMed1982

Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections.

Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.

Acute Disease↗
PubMed1989

Facial paralysis in chronic suppurative otitis media.

Sixty-four patients with a facial paralysis due to chronic suppurative otitis media were treated by surgical decompression during the 10-year period 1973 to 1982. Paralysis was clinically complete in 66% and incomplete in 34% of the patients. Cholesteatoma was found in 80%. Otogenic facial paralysis was more common as an isolated lesion not associated with other complications. When present, bone destruction of the facial canal was most frequently seen in its tympanic portion. The occurrence of facial paralysis did not depend on the extent of destruction of the facial canal. Facial nerve function recovered completely in 70%, partially in 24% and failure occurred in 6% of the patients.

Chronic Disease↗
PubMed1995

Nasal and middle ear ciliary beat frequency in chronic suppurative otitis media.

The middle ear mucociliary system has been shown to have an important function in the clearance of effusions. Little is known, however, about its role in chronic suppurative otitis media (CSOM). The ciliary beat frequencies of middle ear mucosal biopsies and nasal brushings of 27 patients with CSOM were analysed using a computerized photometric technique. The ciliary beat frequency in the middle ear mucosa was significantly less than that in nasal mucosa. Frequency in ears of smoking patients was significantly lower compared with non-smoking patients. Nasal brushings were taken from 27 otherwise healthy age and sex-matched non-smoking controls and the ciliary beat frequency was very similar to nasal samples from patients with CSOM. Ear controls were obtained from otosclerotic patients undergoing tympanotomy and the beat frequency was significantly higher than in the ear of patients with CSOM. It is concluded that middle ear ciliary function is significantly reduced in CSOM, particularly in patients who smoke.

Adolescent↗
PubMed2004

Emergence of ciprofloxacin-resistant pseudomonas in chronic suppurative otitis media.

The most frequently isolated organism in chronic suppurative otitis media (CSOM) is Pseudomonas aeruginosa. Ototopical ciprofloxacin has proven effectiveness against P. aeruginosa. The purpose of this study is to evaluate the patients with recurrent otorrhoea caused by CSOM that was unresponsive to topical ciprofloxacin. Eighty-eight patients (18-77 years of age) with otorrhoea due to CSOM were reviewed retrospectively. All of them were initially treated with ciprofloxacin eardrops but the otorrhoea failed to resolve. Bacteriological specimens were processed and identified with standard cultures. In vitro antimicrobial susceptibility of these bacterial isolates was assessed by an agar disc diffusion method. Isolates were tested against 16 antibiotics. Ciprofloxacin-resistant P. aeruginosa were isolated in all cases. Imipenem was the most sensitive antibiotic agent with an overall susceptibility rate of 96.5%, followed by amikacin (55.6%), piperacillin/tazobactam (37.5%) and ceftazidime (31.8%). In our series, ciprofloxacin-resistant P. aeruginosa is increasing recently. Continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.

Adolescent↗
PubMed1993

Suppurative epididymo-orchitis in young "high risk" patients--a new problem?

During a 4-year period we have treated 3 young patients with severe epididymo-orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of "high risk" activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV-positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure. Investigations for atypical pathogens should be performed when young patients present with refractory epididymo-orchitis. These patients should also be counselled with regard to HIV testing.

AIDS-Related Opportunistic Infections↗
PubMed2001

Management of suppurative pylephlebitis by percutaneous drainage: placing a drainage catheter into the portal vein.

Persistent infection of the portal vein is a rare entity with significant mortality. We present two cases of infected thombis of the portal vein, one infected with fungus and the other with bacteria, both requiring percutaneous drainage to allow a response to antibiotics. The distinction between bland thrombis, infected thrombis, portal venous air, and pneumobilia will be discussed so that suppurative pylephlebitis can be recognized more easily as drain placement appears to affect a more prompt degree of improvement than antibiotics alone.

Candidiasis↗
PubMed1990

Scores of plaque, bleeding, suppuration and probing depth to predict probing attachment loss. 5 years of observation following nonsurgical periodontal therapy.

The purpose of the present study was to determine the diagnostic value of clinical scores of supragingival plaque, bleeding, suppuration and probing depth to predict probing attachment loss in patients on maintenance following nonsurgical periodontal therapy. Non-molar teeth in 39 subjects were monitored and the above scores were repeatedly obtained throughout 5 years of observation following initial treatment. Probing attachment loss between 0-60 months was determined by a combination of linear regression analysis and end-point analysis. The results revealed that all the investigated scores were associated with probing attachment loss. This association was demonstrated by improved diagnostic predictability along with increased frequency or magnitude of the various scores. Also, the diagnostic predictability improved with increase in length of time for recording of the scores. The diagnostic predictability of either accumulated plaque scores and accumulated bleeding scores reached a maximum of about 30%. Residual probing depth greater than or equal to 7 mm reached a predictability of around 50% and increase in probing depth greater than or equal to 1.0 mm reached about 80% after 60 months. Thus, of the clinical scores investigated, increase in probing depth was found to be most valuable in predicting probing attachment loss.

Adult↗
PubMed1993

Unusual suppurative complications of brucellosis in children.

Three cases with suppurative complications of Brucella melitensis infection are presented, demonstrating localized involvement of the brain, bones and lungs, respectively, and the lesions were well defined on radiographic examination. The diagnosis was made on the basis of significant Brucella titres and positive blood culture. Awareness of such complications and performance of the appropriate serological and bacteriological studies will establish the diagnosis and will also differentiate this disease from other infections, especially tuberculosis.

Bone Diseases↗
PubMed1990

[Clinical significance of Streptococcus milleri isolated from various suppurative lesions].

Seventy-one strains of Streptococcus milleri were isolated from 68 patients admitted to Tamana Central Hospital. (1985.2-1989.1) S. milleri was isolated from the following specimens: sputum (15 strains), urine (10), ascites (9), postoperative wound (9), pleural effusate (6), bile (5), genital discharge (3), aspirated fluid from lung abscess (2) and others (12). In 12 patients (18%), S. milleri was isolated in pure culture and in 56 patients (82%) as part of a mixed flora. Other bacteria isolated in association with S. milleri were obligate anaerobes (41%), Gram-negative rods (40%), Gram-positive cocci (16%) and others (3%). In 71 strains of S. milleri, 9 strains (13%) were beta-haemolytic, 62 (87%) were alpha-haemolytic (week) or non-haemolytic. In 68 patients, type specific male-female ratio was 15:9 for S. milleri I, 20:15 for II and 1:8 for III respectively. The patient's age ranged from 7 to 86 years and 75% of patients were more than 50 years old. In respiratory infection, 10 cases (pyothorax, 6; pneumonia, 3; lung abscess, 1) were related to S. milleri infection and considered clinically significant. 8 cases had underlying disease, however, 2 cases (pyothorax, lung abscess) had no underlying disease. In these 2 cases, S. milleri was isolated in pure culture. Successful treatment of these ten cases usually required either antibiotic therapy or drainage of the lesion. S. milleri was isolated from various clinical specimens and some cases were associated with serious infections. S. milleri was more commonly associated with suppurative infections than other viridans group streptococci. S. milleri may therefore have different characteristics which other streptococcal species of normal flora have not.

Abscess↗
PubMed1994

Needle aspiration for suppurative post-BCG adenitis.

The effect of needle aspiration in suppurative post-BCG adenitis was studied. Nodes that had been aspirated (43 patients) regressed in 25 (58%) and 41 (95%) patients two and six months after aspiration. In the control group (34 patients) regression occurred in three (9%) and 22 (65%) patients. Spontaneous drainage with sinus tract formation was also significantly less in the aspirated group at six months (7% v 44%).

BCG Vaccine↗
PubMed1995

Causes of suppurative keratitis in Ghana.

AIMS: Suppurative keratitis is a serious problem in all tropical countries, but very little information is available about the causative organisms in Africa. The objectives were to identify the causative organisms and the proportion of cases caused by fungi in southern Ghana, and to determine whether correct decisions about treatment could be made on the basis of Gram stain in the eye clinic. METHODS: Scrapings were taken from corneal ulcers of consecutive new patients presenting at Korle Bu Hospital, Accra, and inoculated on 'chocolate' and Sabouraud's agars. Further scrapings were taken for Gram staining and interpretation in the eye clinic. Duplicate slides were assessed by an experienced microbiologist in the UK. RESULTS: One or more organisms were cultured from 114 of 199 patients (57.3%), the most common being Fusarium species, Pseudomonas aeruginosa, and Staphylococcus epidermidis. Fungi, alone or in combination, were isolated from 56% of the patients who had positive cultures. In total, 122 patients (61.3%) had their treatment either determined or altered based on the results of the microbiological diagnosis; in 87 of these solely on the basis of direct microscopic examination. CONCLUSIONS: Infection by filamentous fungi accounted for more than half of the ulcers from which cultures were obtained. Both training in technique and experience in interpretation are necessary for microscopy based diagnosis by staff in the clinic to be of greatest value. Direct microscopy was particularly useful for detecting fungi.

Adolescent↗
PubMed1994

Yersinia enterocolitica causing suppurative arthritis of the shoulder.

Yersinia enterocolitica is a rare cause of extra-intestinal disease. A case in a 60 year old butcher with hepatic cirrhosis who developed suppurative arthritis of the shoulder caused by Y enterocolitica is presented. There was no evidence of gastrointestinal infection or septicaemia. The severity of the illness was associated with various factors, including the underlying disease, the type of occupation, and the difficulties encountered in defining the optimal therapeutic regimen.

Arthritis, Infectious↗
PubMed1977

Surgical suppurating infections and surgical abdominal infections treated with fosfomycin.

Two groups of patients suffering surgical infections were treated with fosfomycin. The first includes 21 suppurating dermic of soft underlying tissue lesions. The second group includes 29 surgical abdominal infections. The bacteriology of the first group was made up of gram-positive and gram-negative germs predominantly S. aureus and E. coli, all the isolated species appeared to be sensitive to fosfomycin. In the second group a gram-negative bacterial flora predominantly E. coli was obtained; with a sensitivity to this antibiotic of 90.5%. Surgical treatment accompanied the treatment with fosfomycin. In the first group, all the patients were cured with the oral administration of 2-6 g/day and in an average time less than that of the similar control group which did not receive the antibiotic. In the second group surgical treatment was necessary in 25 of the 29 patients and in all of them parenteral treatment was done with fosfomycin, preferably intramuscularly and in general the dosage was 4 g daily. All patients were cured except for one who was not operated on and who suffered from a fever of undetermined origin.

Abdomen↗
PubMed1991

ELISA to determine immunoreactive Pseudomonas aeruginosa elastase in chronic suppurative otitis media.

A sensitive sandwich ELISA has been developed to measure the levels of Pseudomonas aeruginosa elastase (PE) in ear discharges from chronic suppurative otitis media (CSOM) patients. Preincubation of the sample with EDTA-2Na before ELISA was employed to inhibit PE activity which hydrolyzes the anti-PE IgG antibody into a smaller molecular form. The PE levels of 10 middle ear effusions (MEE) from chronic otitis media with effusion were also measured. In CSOM, 9 of 10 samples had significant PE levels, ranging from 6.8 to 62.1 micrograms/ml, which were significantly higher than those in MEE (p less than 0.01), the majority of which was below the detection limit. Two samples of CSOM with the P. aeruginosa infection showed high PE levels. This sandwich ELISA for the measurement of PE is a very sensitive method requiring only a small sample amount.

Enzyme-Linked Immunosorbent Assay↗
PubMed1994

Controlled prospective study of oral ciprofloxacin versus amoxycillin/clavulanic acid in chronic suppurative otitis media in adults.

The efficacy and tolerability of ciprofloxacin (500 mg twice daily) was compared with that of amoxycillin/clavulanic acid (500 mg three times daily) in 76 patients with acute exacerbations of chronic non-cholesteatomatous suppurative otitis media enrolled in this open randomized multicentre trial. A total of 40 ciprofloxacin-treated patients and 35 amoxycillin/clavulanic acid-treated patients were evaluable for clinical efficacy following the 9-day treatment period. Pseudomonas aeruginosa was the main pathogen isolated prior to treatment. At the end of treatment, otorrhoea had disappeared in 57.5% of the ciprofloxacin group and 37.1% of the amoxycillin/clavulanic acid group (p = 0.04). Bacterial eradication rate was also significantly greater with ciprofloxacin (69.7%) than with amoxycillin/clavulanic acid (27.3%). Both treatments were well tolerated. Ciprofloxacin appears to be an effective treatment of chronic otitis media, and superior to amoxycillin/clavulanic acid.

Adult↗