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October 1988, Volume 38, Issue 10

Original Article


Abdus Salam Khan  ( Department of Pharmacy, Gomal University and Distt: Head Quarter Hospital, D.I.Khan. )
Muhammad Khalid Khan  ( Department of Pharmacy, Gomal University and Distt: Head Quarter Hospital, D.I.Khan. )
Sahibzada Fazli Hameed  ( Department of Pharmacy, Gomal University and Distt: Head Quarter Hospital, D.I.Khan. )
Hayatullah Khan  ( Department of Pharmacy, Gomal University and Distt: Head Quarter Hospital, D.I.Khan. )


Frequency of various organisms and their sensitivity pattern was studied in 33 patients suffering from chronic suppurative otitis media. Thirty Seven percent had Prseudomonas aeruginosa, 27% Staph. aureus, 18% Strep. pyogenes, 15% Proteus and 3% E. Coli infection. Tobramycin was most effective against Pseudomonas and Proteus, Cepharadine against Strept.pyogenes and Augumentin against Staph. aureus infection. Minocyclin demonstrated the best activity against Proteus(JPMA 38: 263, 1988).


Chronic otitis media develops due to un­resolved acute infection, inadequate treatment or the host factors that perpetuate the inflammatory process. Complications of chronic suppurative otitis media are progressive destruction of middle ear structures and a significant risk of permanent loss of hearing1.
The present study was undertaken to determine the frequency of various microor­ganisms responsible for chronic suppurative otitis media (CSOM) and to further assess the changing pattern of their sensitivity to older antibiotics.


Thirty three outdoor patients suffering from CSOM were included in this study. The auricle and external canal were cleaned with antiseptic swab.
The pus samples were taken with the help of sterilized swabs and were streaked on blood agar and Maconkey’s agar . The plates were kept in incubator at 35°C for 18-24 hours.
The organisms were identified with the help of their morphological and cultural character­istics, grams staining and certain specific chemical tests. The standard Bauer-Kirby antibiotics suscep­tibility procedure was followed.
The inoculum was taken with the help of sterilized wire loop and streaked on sensitivity agar plate uniformly. About 7—8 different antibio­tics impregnated discs were placed in each plate. The plates were incubated at 35°C for 18-24 hours. The zone of inhibition for each antibiotics was measured.


The causative organisms in 33 cases of chronic SOM were Pseudomonas aeruginosa (37%), Staph. aureus (27%), Strep. pyogenes (18%), Proteus (15%) and E. coli (3%). Their sensitivity pattern is shown in Tables 1, II, III and IV res­pectively.


The organisms generally responsible for acute suppurative otitis media are, haemolytic streptococcus, Staph. aureus or the Pneumoc­occus. Other organisms sporadically found are H.influenzae, Ecoli, B haemolytic streptococcus, Proteus and Ps. aeruginosa2.
In chronic suppurative otitis media, the bacteriology changes: however the commonest causative organisms isolated have been Ps aerugi­nosa, H. influenzae, Staph. aureus and Proteus species3.
Pseudomonas was the commonest infecting organism in the present series followed by Staph. aureus, Strept. pyogenes, Proteus species and E. Coli.
Since the causative pathogens in chronic otitis media vary widely it is suggested that medical treatment should not be started unless culture and sensitivity report is at hand. It has been reported that the use of systemic antibiotics plays an important role in the management of otitis media4.
When the causative organism is other than Pseudomonas, it is better to use other non toxic, convenient and less expensive drugs like Min ocyclin, Augumentm and Cephradine.
This study has shown that the organisms responsible for chronic suppurative otitis media have become relatively resistant to antibiotics like
Ampidillin, Ampiclox, Amoxycfflin, Cotrimoxa­zole, and Erythromycin.
Among the aminoglycocides tobramycin was found to be more effective against Pseudomonas aeruginosa as compared to Gentamycin and Brulamycin. The difference in response was statistically significant (P> .05).


1. Sherris, J.C. An introduction to infectious diseases, New York, Elsevier, 1984, p. 570.
2. Shambaugh, G.H. Pathology and clinical course of inflammatory diseases of the middle ear, in surgery of the ear. 2nd ed. Philadelphia, Saun­ders, 1967,p. 187.
3. Mawson, S.R. and Ludman, H. Diseases of the ear. 4th ed. London, Edward Arnold, 1979, p. 329.
4. Krupp, MA., Chatton, MJ. and Werdegar, D. Current medical diagnosis and treatment. Los Altos California, Lange, 1985, p. 110.

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