What is the treatment for malignant otitis externa?

• A. Long-term intravenous antibiotics, typically ciprofloxacin
• B. Short course oral antibiotics
• C. Topical antifungals
• D. Oral steroids

Answer: (A)

Malignant otitis externa is a deep, potentially skull-base–osteomyelitis caused most often by Pseudomonas in diabetics or immunocompromised patients. Because the infection involves bone and can spread, it requires aggressive anti-pseudomonal therapy given for weeks to ensure adequate drug levels at the site and complete eradication. Intravenous antibiotics are preferred initially to achieve the necessary tissue penetration and to control the infection promptly. Ciprofloxacin is commonly chosen because it has strong activity against Pseudomonas and good penetration into bone and ear tissues, making it a practical option for prolonged IV therapy or for step-down to oral therapy once the patient stabilizes. Short courses or relying on topical treatments don’t reach the deep-seated infection, and steroids do not treat the underlying bacterial process. Thus, long-term intravenous antibiotics are the appropriate and most effective approach.