Chronic suppurative otitis media: A microbiological review of 20 years

Chronic infection of the middle ear cleft for at least 2 weeks or more is known as chronic suppurative otitis media (CSOM). It usually manifests as a complication of acute otitis media. It is more prevalent in developing countries due to various predisposing factors such as malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infection. Due to advancement in medical facility, India still falls under high prevalence zone. In India, the average prevalence of CSOM is 5.2%. Pseudomonas aeruginosa and Staphylococcus aureus were the predominant isolates in most of the studies. Other common aerobic isolates were Klebsiella spp., Proteus spp., Escherichia coli, Bacteroides fragilis, Prevotella spp., Candida spp., and Aspergillus spp. However, there was no significant geographical variation of pathogens in India. In recent years, there is increased preponderance of multidrug-resistant organisms due to the irrational use of antibiotics, making treatment of CSOM more difficult. Colistin and polymyxin-B were the most effective antibiotics which showed sensitivity against P. aeruginosa by up to 100%. Carbapenems were showing good sensitivity against P. aeruginosa in most of the studies, but there was decreased tendency of sensitivity for piperacillin-tazobactam, amikacin, gentamicin, ceftazidime, and ciprofloxacin. Nine studies isolated methicillin-sensitive S. aureus significantly higher in number than methicillin-resistant S. aureus. For S. aureus, vancomycin and linezolid showed ≥90% sensitivity in most of the studies. Amikacin, gentamicin, erythromycin, and ciprofloxacin were other active drugs against S. aureus, which were showing resistant pattern significantly.