study of otomycosis in Karachi

In a multicenter study of 544 consecutive ear-swab referrals cultured during a 9-month period ending June 1999. Staph. aureus [38.6%] and Pseudomonas spp. [28.5%] accounted for 67% of isolates among 10 bacterial species, Aspergillus niger [7.1%] and Candida albicans [3.8%] were two fungal agents also recognized. Subjects clinically suspected of otomycosis presented mainly with chronicity, itching and fullness of ear, sometimes with hearing impairment, otorrhoea and occasionally pain, gender and age were other unidirectional variables did not influence the study. Sterile alginate-tipped swabs of wet discharge of desquamated material from the external auditory canal were examined directly by light microscopy of a smear in 20% KOH, and by paired culture on Sabouraud-Dextrose and Chocolate agar plates incubated at 30°C and 37°C for 1-3 days. Aspergilli were visible in some cases with mycelium in black-gray clumps in the external ear canal, in contrast to Candida, which presented with a whitish discharge

Suppurative otitis in Karachi: an audit of 510 cases

Suppurative disease of the middle ear is a constant challenge for otologists to treat. "Watchful waiting" may be acceptable for a few cases, but possibly all patients with chronic otitis media should receive antimicrobial therapy to minimize mastoid pathologies. Selection of a potentially effective drug, however, in the absence of discharge culture analysis, depends on the regional prevalent microflora. In a multicentre study of 596 consecutive ear-swab referrals processed during a 10-month period ending July 1997. Staph. aureus [40.4%] and Pesudomonas [29.6%] accounted for 70% of isolates among 10 bacterial species. Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting possible other or non-infective aetiology. The finding that pseudomonas was increasingly implicated in recent months warrants tailored drug prescription; moreover, 37.9% of our Staph isolates were beta-lactamase producers and methicillin-resistant, necessitating the choice of "enzyme-stable" antibiotics for first-line use. The high number of gram-negative aerobes isolated from our cases of otitis media casts serious doubt on the role of the nasopharynx as the major contributor to this infective process; an alternate presumption that the faecal-aural route is often involved, seems more practical in our environment

open ended clinical trial of ciprofloxacin in upper respiratory tract infections

Ciprofloxacin is a 4-quinolone derivative with a broad antibacterial spectrum covering gram-negative rods particularly pseudomonas and gram-positive cocci. A clinical trail was conducted in randomly selected 69 patients with upper respiratory tract infections. The drugs was given in oral form in equal dosage on 6 hourly basis [250 and 500 mg]. The response rate was 96.6% with symptoms and signs disappearing by 3rd day in 35 [60.34%] patients, by 5th day in 21 patients [32.6%]. Bacterological profile showed excellent response in all the patients