In the literature, there is no consensus on the most effective treatment protocol for Necrotising otitis externa (NOE). This article aims to produce a NOE treatment protocol from literature and clinical experience.
26 case series studies were reviewed in combination with a retrospective case series of inpatients from Hull University Teaching Hospitals Trust. Over 5 years, 40 patients were identified with 29 being analysed due to unavailable or incomplete case notes.
The most common bacteria causing NOE was Pseudomonas aeruginosa. Resistance to ciprofloxacin was prevalent; however multidrug resistance was rare. Ciprofloxacin and Ceftazidime were the most widely used antibiotics. No ceftazidime resistance was reported in the literature or our cohort. The average age of the patients in our cohort was 80 years. Sixty-two percent had either diabetes or were immunosuppressed. One patient died directly due to NOE related sepsis. Intravenous ceftazidime monotherapy was mostly used. The duration of treatment was 6-7 weeks, with no relapses documented.
Ceftazidime monotherapy was an effective empirical treatment in our cohort, and a total duration of 6-7 weeks of antibiotics was sufficient. We have created a standardized treatment protocol based on our findings which will need to be validated in a larger cohort of patients.

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