Published: 2018-02-22

Therapeutic guidelines for antimicrobial use in chronic suppurative otitis media for a tertiary care hospital in Sub Himalayan region

Sushma Sawaraj, Sunder Singh Dogra, Dinesh Kansal, Kamlesh Thakur, Parveen Kumar Sharma


Background: The battle against micro-organisms, in their role as primary cause of the disease and infective complications of medical and surgical techniques, has not decreased in spite of modern antimicrobial therapy. Chronic suppurative otitis media (CSOM) is a disease with worldwide prevalence having potentially serious long term effects. The disease remains an important global public health problem leading to hearing impairment, and due to wide spread irrational use microbial resistance is very common to these antibiotics, thereby leading to treatment failure. Hence it is important to know the type of bacteria and their sensitivity pattern so that appropriate antibiotics may be given for treatment and prevention of complications.

Methods: 428 patients of otitis media were enrolled from ENT OPD of Tertiary Care Hospital. Ear swab was taken from diagnosed cases of CSOM and culture and sensitivity were done.

Results: The microbiology of the swab showed no growth in (25.4%) of samples. Staphylococcus aureus (26%) and Pseudomonas (25%) were the main organisms isolated. Staphylococcus aureus isolated was sensitive to vancomycin, clindamycin, cefixime, gentamicin and cefipime in descending order. Pseudomonas aeruginosa was sensitive to ceftazidime, imipenem, piperacillin, gentamicin, cefipime. In the present study Staph. aureus and Pseudomonas were the predominant bacteria, it is suggested to undertake a gram staining in all patients. If gram positive organisms are isolated it is suggested that presumptive treatment should be directed against Staphylococcus aureus and if gram negative then against Pseudomonas aeruginosa. Such a treatment is not only likely to be effective but will also go a long way in preventing emergence of drug resistance.

Conclusions: The antimicrobial therapy should be based on locally determined microbiological isolates and local sensitivity patterns to a particular antimicrobial agent. The presumptive antimicrobial therapy should therefore be directed against these organisms.


CSOM, Culture and sensitivity, Klebsiella, Pseudomonas, Staphylococcus aureus, Therapeutic guidelines

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Thomson R, Lavender M, Madhok R. How to ensure that guidelines are effective? BMJ. 1995;311:237-42.

Turnidge J. Antibiotics in animals – much ado about something. Aust Prescr. 2001;24:26-7.

Quale J, Landman D, Saurina G, Atwood E, DiTore V, Patel K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis. 1996;23:1020-5.

Saurina G, Quale JM, Manikal VM, Oydna E, Landman D. Antimicrobial resistance in Enterobacteriaceae in Brooklyn, NY: epidemiology and relation to antibiotic usage patterns. J Antimicrob Chemoth ER. 2000;45:895-8.

McNulty C, Logan M, Donald IP, Ennis D, Taylor D, Baldwin RN. Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy. J Antimicrob Chemother. 1997;40:707-11.

Landman D, Chockaling M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis. 1999;28:1062-6.

Writing group for Therapeutic Guidelines: Therapeutic Guidelines: Antibiotic. 12th edition. Melbourne: Therapeutic Guidelines Ltd.; 2003.

Ball P, Baquero F, Cars O, File T, Garau J, Klugman K, et al. Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence J. Antimicrob. Chemother. 2002;49:31-40.

Woodhead, M. Community-acquired pneumonia guidelines - an International comparison: a view from Europe. Chest. 1998;113:183-7.

Colle JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie & McCartney Practical Medical Microbiology. 14th Ed. Edinburgh: Churchill Livingstone; 2006.

Bauer AW, Kirby WN, Sherris JC. Antibiotic susceptibility testing by standardized single disc method. Am J Clin Pathol. 1966;45:49-50.

Clinical and laboratory standards institute. Performance standards for antimicrobials susceptibility testing twenty first informational supplement M100S21. Wayne, PA: CLSI; 2011.

Winn WC, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al. Koneman’s Color atlas and textbook of Microbiology. 6th ed. Philadelphia: Lippincott Williams and Willkins; 2006.

Sweetman SC. editor. Martindale; the complete drug reference. 36th Ed. Chicago: Pharmaceutical press; 2007.

Gulati CM, editor. Monthly index of medical specialties. New Delhi: Indraprastha press; 2014.

Adoga AA, Bakari A, Afolabi OA, Kodiya AM, Ahmad BM. Bacterial isolates in chronic suppurative otitis media: a changing pattern? Niger J Med. 2011;20:96-8.

Madana J, Yolmo D, Kalaiarasi R. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol. 2011;75:1104-8.

Afolabi OA, Salaudeen AG, Ologe FE. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria. AFR Health Sci. 2012;12:362-7.

Prakash M, Lakshmi K, Anuradha S, Swathi G. Bacteriological profile and their antibiotic susceptibility pattern of cases of chronic suppurative otitis media. Asian J Pharm Clin Res. 2013;6:210-2.

Taneja M, Taneja MK. CSOM a bacteriological study. Indian J Otol. 2009;15:3-7.

Kuchhal V. Antibiotic sensitivity pattern in chronic suppurative otitis media in kumoun region. Indian J Otol. 2010;16:17-21.

Shyamla R, Reddy SP. The study of bacteriological agents of chronic suppurative otitis media-aerobic culture and evaluation. J Microbiol Biotechnol Res. 2012;2:152-62.

Prakash R, Juyal D, Negi V. Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Setup of Uttarakhand State, India. N Am J Med Sci. 2013;5:282-7.

Chakraborty A, Bhattacharjee A, Purkaystha P. Microbiological profile of chronic suppurative otitis media: Its significance in North-East India. Indian J Otol. 2005;11:39-44.

Malkappa SK. Study of aerobic bacterial isolates and their antibiotic susceptibility pattern in chronic suppurative otitis media. Indian J Otol. 2012;18:136-9.