ENT 1.2 Malignant otitis externa - Pseudomonas aeruginosa

Recommendations

≥ 18 years
	Dosage	Remarks
	ciprofloxacin orally 750 mg twice daily for 4 to 12 weeks	Mild cases Combine systemic therapy with local therapy If Pseudomonas is proven susceptible
	ceftazidime IV 2000 mg three times daily for 4 to 12 weeks	Severe cases Combine systemic therapy with local therapy If there is a good response and Pseudomonas is proven susceptible, switch to ciprofloxacin 750 mg orally twice daily

Local therapy

Otiflox 3 mg/ml (0.5 ml; 1 pack) instil 7 drops twice daily into the ear canal of the affected ear

Total treatment duration is 4 to 12 weeks, depending on clinical presentation and imaging

When using ear drops in the presence of a perforated tympanic membrane, stop treatment if tinnitus, dizziness or acute hearing loss occur