In otitis externa, the most common pathogen is Pseudomonas aeruginosa. Which topical regimen is traditionally used?

In otitis externa, the most common pathogen is Pseudomonas aeruginosa. Which topical regimen is traditionally used?

• A. Staphylococcus aureus; cefazolin
• B. Streptococcus pneumoniae; amoxicillin
• C. Pseudomonas aeruginosa; oral ciprofloxacin
• D. Pseudomonas aeruginosa; topical polymyxin, neomycin, and hydrocortisone

Answer: (D)

Otitis externa is most effectively treated with topical therapy that delivers high concentrations directly to the infected external ear canal, because Pseudomonas aeruginosa is the classic offender and systemic therapy is often unnecessary for mild cases. The traditional topical regimen combines an anti-pseudomonal antibiotic with a mild steroid to reduce inflammation and itching, improving drainage and symptom relief. Polymyxin B targets Gram-negative organisms like Pseudomonas, neomycin broadens coverage, and the hydrocortisone component helps quell edema and irritation. This combination has long been a standard approach for otitis externa. Other options miss the typical pathogen or the route of administration. One emphasizes a Staphylococcus aureus target with a systemic antibiotic, which isn’t the usual approach for topical treatment of this canal infection. Another centers on Streptococcus pneumoniae with amoxicillin, which is not the common cause here. The oral ciprofloxacin regimen covers Pseudomonas but is systemic rather than topical, and the question asks specifically for a topical regimen.

Otitis externa is most effectively treated with topical therapy that delivers high concentrations directly to the infected external ear canal, because Pseudomonas aeruginosa is the classic offender and systemic therapy is often unnecessary for mild cases. The traditional topical regimen combines an anti-pseudomonal antibiotic with a mild steroid to reduce inflammation and itching, improving drainage and symptom relief. Polymyxin B targets Gram-negative organisms like Pseudomonas, neomycin broadens coverage, and the hydrocortisone component helps quell edema and irritation. This combination has long been a standard approach for otitis externa.

Other options miss the typical pathogen or the route of administration. One emphasizes a Staphylococcus aureus target with a systemic antibiotic, which isn’t the usual approach for topical treatment of this canal infection. Another centers on Streptococcus pneumoniae with amoxicillin, which is not the common cause here. The oral ciprofloxacin regimen covers Pseudomonas but is systemic rather than topical, and the question asks specifically for a topical regimen.