Treatment of culture-negative skull base osteomyelitis.
OBJECTIVE
To evaluate the efficacy of a therapeutic regimen in the treatment of patients with culture-negative skull base osteomyelitis.


METHODS
Retrospective case review.


METHODS
Tertiary referral hospital.


METHODS
Eight patients with diabetes mellitus presented with otalgia and were found to have positive technetium and gallium scans of the temporal bone. These patients, however, all had negative cultures of their external auditory canals. All patients had been treated with ototopic drops and two patients had undergone a 2-week course of oral quinolones.


METHODS
All patients were treated with a 6-week course of intravenous ceftazidime or aztreonam for penicillin-allergic patients, oral ciprofloxacin at a higher dose than normal, and topical aminoglycoside steroid drops.


METHODS
Resolution of the temporal bone gallium scan abnormality, recurrence rate, and time to discharge from the hospital.


RESULTS
The patients were discharged from the hospital within 4 days from admission. All patients showed resolution of the temporal bone abnormality on the gallium scan at the 6-week time point. The median follow-up period was 6 months, and none of the patients had a recurrence of the infection.


CONCLUSIONS
The above-described treatment regimen will result in a high cure rate and a short hospitalization period.
Djalilian
Hamid R
HR
Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Charles R. Drew University of Medicine and Science, Los Angeles County Hospital, Los Angeles, California, USA. skullbasesurgery@yahoo.com
Shamloo
Bahman
B
Thakkar
Kunal H
KH
Najme-Rahim
Mojdeh
M
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001398:Aztreonam / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D048909:Diabetes Complications / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology*; D013667:Technetium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D013667:Technetium; D002442:Ceftazidime; D001398:Aztreonam