A study of prescription pattern in the drug therapy of CSOM at a tertiary care hospital in eastern part of India
Keywords:CSOM, Microbiological pattern, Prescription pattern, Antibiotics, Sensitivity
Background: Chronic suppurative otitis media (CSOM) is a perforated tympanic membrane with persistent drainage from the middle ear (i.e. lasting >6-12 weeks). A prospective study was undertaken to find out the baseline data on the prescribing pattern of drugs in the treatment of chronic suppurative otitis media.
Methods: A cross-sectional observational study was conducted on 125 patients attending ENT OPD and microbiology laboratory of a tertiary care teaching hospital with ear discharge and other symptoms and signs of CSOM.
Results: Unilateral infection is more common 82 (65.6%) than bilateral and mostly affects lower socio-economic conditions 90 (72 %). The single bacterial isolate was seen in 102 (81.6%) cases. The mixed growth (contamination) was observed in 12 (9.6%) cases, The 11 (8.8%) cases were found sterile. Higher sensitivity (75%- 95%) was observed with cefuroxime (76.6%), piperacillin/tazobactam (78.7%), doxycycline (85.1%), amikacin (89.4%), and moxifloxacin (93.6%). It showed 38.3% sensitivity with ampicillin, 55.3% with ciprofloxacin, and 61.7% with macrolides. Levofloxacin (85.1%) was more sensitive than ciprofloxacin.
Conclusions: Evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area become helpful in prescribing empirical antibiotics for successful treatment of otitis media and thus minimizing its complications and emergence of resistant strains.
Background: Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in hemostasis, tissue repairing and inflammation. Recently, mean platelet volume (MPV) was recognized as a simple inflammatory marker in the inflammatory disease. This study investigated the relationship of nasal polyps with MPV (mean platelet volume), platelet count and NLR (neutrophil to lymphocyte ratio).
Methods: The cross-sectional observational study we investigated CBC (complete blood count) parameters of the patients that consulted ENT clinic in a tertiary care teaching hospital, Haldia because of nasal polyp. About 76 patients and 42 controls were included in this study. In all groups, WBC (white blood cell count), RBC (red blood cell count), RDW (red cell distribution width), platelet count, MPV, PDW (platelet distribution width) and NLR parameters from CBC (complete blood count) were compared between patients and controls.
Results: Mean WBC values were 6.89±1.33×103/μL in patients with NPs, vs. 7.11±2.32×103/μL in the control group. Mean haemoglobin (Hb) values were 13.19±1.34 g/dL in patients with NPs, vs. 14.1±1.67 g/dl in the control group. Mean MPV values were 9.11 ± 1.08 fL in patients with NPs, vs. 8.32±0.53 fL in the control group. Mean PLT values were 232.38 ± 39.97×103/μL in patients with NPs, vs. 271.44±45.14×103 in the control group. MPV was higher in nasal polyp patients, whereas platelet count was higher in controls. The difference was significant for the mean absolute neutrophil, platelet count, and lymphocyte counts, NLR, PDW and MPV values between the study group and the control group.Conclusions:Platelet count and NLR were significantly lower in patients than the controls, whereas MPV was significantly higher in nasal polyp patients.
Acuin J. Department of Child and Adolescent health Development and Team for Prevention of Blindness and Deafness. Chronic suppurative otitis media: burden of illness and management options. Geneva: World Health Organization. 2004. Available at: http://apps.who.int/iris/handle/10665/42941. Assessed on November 11, 2016.
Meyerhoff WL, Kim CS, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhinol Laryngol. 1978;87(6):749-60.
Kenna MA. Microbiology of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988. 97(131):9-10.
Senturia BH, Bluestone CD, Klein JO, Lim DJ, Paradise JL. Report of the AD HOC committee on definition and classification of otitis media and otitis media with effusion. Ann Otol Rhinol Laryngol. 1980;89:3.
Bluestone CD. Epidemiology and pathogenesis of chronic suppurative otitis media: Implications for prevention and treatment. Int J Pediatr Otorhinolaryngol. 1998;42:207-23.
McKenzie W, Brothwell D. Disease in the Ear. Disease in Antiquity. 1967: 464-73.
Kong K, Coates HL. Natural history, definitions, risk factors and burden of otitis media. Med J Aust. 2009;191(9):39-43.
van der Veen EL, Schilder AG, van Heerbeek N, Verhoeff M, Zielhuis GA, Rovers MM. Predictors of chronic suppurative otitis media in children. Arch Otolaryngol Head Neck Surg. 2006;132(10):1115-8.
Poorey VK, Lyer A. Study of bacterial flora in csom and its clinical significance. Indian J Otolaryngol Head Neck Surg. 2002;54(2):91-5.
Tomasz A. Multiple-antibiotic resistant pathogenic bacteria. A Report on the Rockfeller University Workshop. N Engl J Med. 1994;330(17):1247-51.
Alo MN, Anyim C, Okonkwo EC, Orji JO. Prevalence, antibiogram of bacterial pathogens associated with otitis media among primary school children in Ebonyi State. IOSR J Pharm Biol Sci. 2012;1:17‑20.
Indudharan R, Haq JA, Aiyar S. Antibiotics in chronic suppurative otitis media: A bacteriologic study. Ann Otol Rhinol Laryngol. 1999;108:440‑5.
Kenna MA, Bluestone CD, Reilly J. Medical management of chronic suppurative otitis media without cholesteatoma in children. Laryngoscope 1986; 96:146‑51.
Shyamala R, Reddy PS. The study of bacteriological agents of chronic suppurative otitis media: Aerobic culture and evaluation. J Microbiol Biotech Res. 2012;2:152‑62.
Teele DW, Klein JO, Rosner B. Greater Boston Otitis Media Study Group. Epidemiology of otitis media during the first seven years of life in children in greater Boston: A prospective, cohort study. J Infect Dis. 1989;160:83‑94.
Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol. 2008;122(5):442-6.
Tahir M, Jawaid A, Abdullah A, Najam MA. Bacterial culture and sensitivity in active chronic otitis media: 500 cases in combined military hospital Rawalpindi. Pak J Otolaryngol. 2012;28:56‑8.
Madana J, Yolmo D, Kalaiarasi R, Gopalakrishnan S, Sujata S. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol. 2011;75:1104‑8.