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. Study Design: Retrospective case review. Setting: Tertiary referral hospital. Patients: 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. Interventions: 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 ammoglycoside steroid drops. Main Outcome Measures: 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. Conclusion: The above-described treatment regimen will result in a high cure rate and a short hospitalization period.