What is the typical route and drug class used for malignant otitis externa treatment?

• A. Oral antibiotics such as amoxicillin
• B. Topical antibiotics
• C. Intravenous antibiotics, typically fluoroquinolones
• D. Antifungal therapy

Answer: (C)

Malignant otitis externa is an invasive infection that extends beyond the ear canal, often toward the skull base, and it demands systemic treatment because topical therapy won’t reach the deep tissues or bone. The infection is most concerning for Pseudomonas aeruginosa, so therapy must provide anti-pseudomonal coverage and good tissue penetration. The best approach is intravenous antibiotics started in the hospital to ensure adequate levels in bone and dense infected tissue. Fluoroquinolones are the preferred class because they have strong anti-pseudomonal activity and penetrate bone well, with ciprofloxacin being a classic example used in this setting; many patients may transition to oral fluoroquinolones once they improve. Topical antibiotics alone are insufficient for MOE, and antifungal therapy is reserved for fungal infections. Amoxicillin would not adequately cover Pseudomonas and is not appropriate for this invasive process.