Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis.
Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis.
复制标题
口服环丙沙星联合利福平治疗恶性外耳炎的疗效。
DOI：
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发表时间：
1989
期刊：
影响因子：
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通讯作者：
D. Kamerer
中科院分区：
文献类型：
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作者：
J. Rubin;G. Stoehr;V. Yu;R. Muder;Akbar Matador;D. Kamerer
恶性外耳道炎是一种侵袭性的假单胞菌感染，好发于老年糖尿病患者。传统的治疗方法是长期联合使用肠外抗生素，但尽管采用这种治疗方法，发病率和死亡率仍然很高。我们连续治疗11例患者，口服环丙沙星（750毫克，每日两次）和利福平（600毫克，每日两次）6至12周（平均8周）。铜绿假单胞菌分离出耳道或乳突，骨破坏记录在所有患者的计算机断层扫描。7名患者（64%）在感染发生前进行了耳部冲洗。10例患者符合临床和细菌学治愈的标准。两种抗生素均未观察到严重不良反应。治疗开始后，耳痛和耳痛分别在平均6天和4天内缓解。红细胞沉降率从治疗前的平均值81 mm/h（范围：41 - 138 mm/h）下降到抗生素治疗完成后的18 mm/h（范围：3 - 45 mm/h）。最低抑菌浓度和杀菌浓度确定所有微生物对环丙沙星敏感。时间-杀灭曲线和棋盘格试验未能证明环丙沙星和利福平之间的协同作用或拮抗作用。血清抑制和杀菌滴度显示，加入利福平后，细菌的抑制和杀灭作用略有增加。利福平不会改变环丙沙星的药代动力学。口服抗生素治疗这种难治性感染的成功使用可能是一个重大进展。抗生素费用和住院费用的减少以及口服给药的便利性具有显著的益处。
Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin. The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit.