Chronic suppurative otitis media that often acompanies chronic M is treated with topical antimicrobial therapy and thorough aural toilet and system antimicrobials are given if this approach fails. The empirical choice of systemic antimicrobials for chronic M is directed at the eradication of both aerobic and anaerobic bacteria. Some of the anaerobic organisms, such as B. fragilis, and many pigmented Prevotella and Porphyromonas and Fusobacterium spp. are resistant to penicillins through the production of the enzyme beta-lactamase.
Clindamycin, cefoxitin, metronidazole, chloramphenicol, or the combination of amoxicillin or ticarcillin and clavulanic acid provides coverage for anaerobic bacteria (31). Coverage for some aerobic bacteria is achieved by several of these agents. Antimicrobials effective against S. aureus and the aerobic gram-negative bacilli including P. aeruginosa, may be also needed. Whenever methicillin-resistant S. aureus is present vancomycin, tigecycline or linezolid should be administered instead of beta-lactam resistant penicillin (i.e., oxacillin). An aminoglycoside, a third generation cephalosporin (i.e., ceftazidine or cefepime), or a quinolone (in adults) should be considered for coverage of aerobic gram-negativebacilli (16-21). The carbapenems (i.e., imipenem, meropenem) or tigecycline provide single agent therapy for all potential pathogens. Oral therapy can substitute parenteral agent(s) if improvement occurred, for a total of six weeks of treatment.
Surgical drainage is indicated in many cases. The drained material should be Gram-stained and cultured. The reading of the Gram's stain and the results of the cultures and sensitivities allows for adjustments in the choice of antimicrobial agents.
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