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Necrotising Otitis Externa Antibiotic therapy complications: A retrospective cohort analysis
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  • Ali Ijaz,
  • Emma Williams,
  • Joby Cole,
  • Glen Watson
Ali Ijaz
Sheffield Teaching Hospitals NHS Foundation Trust

Corresponding Author:[email protected]

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Emma Williams
Sheffield Teaching Hospitals NHS Foundation Trust
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Joby Cole
Sheffield Teaching Hospitals NHS Foundation Trust
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Glen Watson
Sheffield Teaching Hospitals NHS Foundation Trust
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Introduction: Necrotising otitis externa (NOE) is a serious, progressive infection of the external ear canal. If untreated, it can invade into temporal bone, skull-base and surrounding tissue resulting in cranial nerve palsies, neurological infections and death. Patients present with unremitting, severe otalgia, otorrhoea and oedematous ear canals containing granulation. Surgery has a limited role; the mainstay of treatment involves a long course of intravenous antibiotics. Currently, there is no data on the complications of antibiotic treatment for NOE. This project aims to provide evidence on the nature/frequency of severe treatment-related complications requiring a change in antibiotic regime. Methods: A retrospective 5-year cohort analysis was performed on 64 patients who were treated for confirmed NOE with intravenous antibiotic therapy. Clinical notes, blood results and antibiotic prescriptions were documented and analysed. Results: Average duration of treatment was 11 weeks (range=38 weeks). There was an average of 2.1 antibiotic regimes per patient with 10 cases requiring inpatient admission due to treatment-related complications. 63% of treatment changes were directly related to adverse effects of intravenous antibiotics. Drug allergy/intolerance (n=18) and clinical deterioration i.e. Lack of symptomatic improvement and/or worsening inflammatory markers (n=18), were the most common reasons for antibiotic change. Neutropenia, deranged liver function tests and acute kidney injury were also recognised adverse effects of treatment. Conclusion: This study provides the first evidence on the notable frequency of antibiotic-related complications in NOE patients. Larger, multicentre studies are required in the future to validate our findings and will better inform both clinicians and patients of the risks of treatment.
28 Nov 2021Submitted to Clinical Otolaryngology
12 Dec 2021Submission Checks Completed
12 Dec 2021Assigned to Editor
18 Dec 20211st Revision Received
25 Dec 2021Submission Checks Completed
25 Dec 2021Assigned to Editor
27 Dec 2021Reviewer(s) Assigned
23 Jan 2022Review(s) Completed, Editorial Evaluation Pending
30 Jan 2022Editorial Decision: Revise Minor
09 Feb 20222nd Revision Received
11 Feb 2022Submission Checks Completed
11 Feb 2022Assigned to Editor
11 Feb 2022Reviewer(s) Assigned
12 Feb 2022Review(s) Completed, Editorial Evaluation Pending
13 Feb 2022Editorial Decision: Accept
Mar 2022Published in Clinical Otolaryngology. 10.1111/coa.13921