Prolonged antipseudomonal parenteral
antibiotic therapy combined with daily aural
toilet has been effective in resolving long standing ear discharge in children with chronic
suppurative otitis media. However, such treatment suffered from the disadvantages of prolonged hospitalization. We conducted a prospective study to investigate the feasibility and efficacy of exclusive outpatient treatment of children with chronic
suppurative otitis media without
cholesteatoma who had failed ototopical/oral antimicrobial
therapy. The treatment consisted of daily aural
toilet (suction and
debridement) and twice daily parenteral
ceftazidime (50 mg/kg/dose). Thirty-seven children were included. The duration of discharge from the ear before treatment was 6 to 121 months (median, 30 months). Aerobic cultures yielded Pseudomonas aeruginosa in 97%, often with other organisms. The management and follow-up were performed jointly by otolaryngology and
infectious diseases physicians using the hospital ambulatory services. The route of
ceftazidime administration (intravenous or intramuscular) was chosen according to the parents' and patients' convenience. Discharge stopped within 3 to 20 days (median, 8 days) in all children but one. Seventy-six percent of the 29 children available for follow-up 12 months
after treatment were still free of discharge. Our results demonstrate that a regiment combining daily aural
toilet and twice daily parenteral
ceftazidime is highly efficacious in resolving ear discharge in children with chronic
suppurative otitis media without
cholesteatoma and that such a regimen does not require hospitalization.