Author(s)
Hilario Yankey1, Glenn Isaacson1,2
Affiliation(s)
1 Temple University
Abstract:
Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) makes up 3-16% of pediatric tympanostomy tube otorrhea (TTO). As many strains are resistant to common ototopical drops and oral antibiotics, there is no standard treatment. Initial treatment failures and recurrence of otorrhea after successful treatment are common. We assessed the efficacy of topical 2% mupirocin ointment as an adjunct to systemic antimicrobials for the treatment of pediatric CA-MRSA tube otorrhea. Methods: We conducted a retrospective review of children treated with a 1ml application of topical 2% mupirocin ointment for culture-proven CA-MRSA TTO and compared them to children treated with systemic agents and ototopical drops (controls). Resolution of otorrhea and recurrence of CA-MRSA during follow-up were major outcome measures. Results: Eight children (mean age 3.5 years) were treated with mupirocin - 21 children (mean age 5.3 years) were not. All the patients in both cohorts had resolution of otorrhea at the end of various treatments. Intravenous vancomycin, oral linezolid or tube removal were required for resolution of otorrhea only in the control group. Recurrence of CA-MRSA TTO in the mupirocin and control groups were 0% and 38%, respectively (p = 0.040). Follow-up in the control group was longer (24 vs 7 months). No new sensorineural hearing loss occurred in the mupirocin-treated children. Conclusions: The additional of topical mupirocin to common oral agents resulted in cure of all children with CA-MRSA TTO without the need for intravenous vancomycin, linezolid or surgical tube removal. CA-MRSA recurrence was significantly less common in the mupirocin-treated children.