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A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Published online by Cambridge University Press:  28 September 2023

Sirat Lodhi Open the ORCID record for Sirat Lodhi [Opens in a new window] ,
Sara Timms  and
Emma Stapleton Open the ORCID record for Emma Stapleton [Opens in a new window]
Sirat Lodhi
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
Sara Timms
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
Emma Stapleton*
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
*
Corresponding author: Emma Stapleton; Email: emmastapleton@doctors.org.uk
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Abstract

Background

Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa.

Methods

The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (‘PRISMA’) guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed.

Results

Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes.

Conclusion

Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.

Keywords

Otitis externaosteomyelitisdiabetes mellitusimmunosuppression
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 2 , February 2024 , pp. 120 - 129
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Emma Stapleton takes responsibility for the integrity of the content of the paper

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