Treating Pediatric Pseudomonas Infections

Moisture can cause swimmer's ear

The seaside vacation had been fun, but the 9-year-old couldn’t say the same about the trip back home. The boy had practically lived in the water during the wonderful week at the beach. Now he was apparently paying the price as he dealt with a case of excruciating left ear pain.

The family had just driven in from the coast and brought their son to the office for an exam. I listened to my patient’s lungs and checked for swollen neck glands, then examined his “good” ear, which had a normal canal and eardrum. I checked the left ear last, and even my gentle tug on the outer ear caused the boy to wince in pain.

While the child’s left eardrum was free of infection, the left ear canal was swollen, flaked, red and coated with a thin liquid discharge. I placed a wick — a slender piece of material that expands like a sponge when wet — in his ear canal and applied some medicated drops. The cool liquid seemed to give the young patient some relief.

Swimmer’s ear sounds like a trivial infection, but this ear canal inflammation — also known as acute otitis externa — can be a very painful condition, often reducing patients to tears. A recent study by the Centers for Disease Control and Prevention finds that AOE is also financially painful, accounting for 2.4 million U.S. health care visits per year with an annual direct cost of nearly half a billion dollars.

The highest rate of AOE-related visits occurs among kids aged 5 to 14 years. AOE is linked to water exposure and warm, humid environments, so it’s not surprising this common ear condition peaks in the summer months and is most often seen in the Southern states.

In their Pediatrics in Review journal article “Otitis Externa,” Drs. Kimberly Stone and Janet Serwint explain that moisture in the ear canal causes swelling and skin breakdown, allowing bacteria such as pseudomonas and staphylococcus to multiply in the ear.

Pediatrics Article | Pseudomonas Aeruginosa

Mayer–Hamblett N et al. – Children with cystic fibrosis (CF) who fail to eradicate after initial antibiotic treatment are at higher risk of subsequent exacerbation, suggesting clinical benefit to successful early eradication of Pseudomonas aeruginosa (Pa) infection.

Methods The cohort included 282 children with CF who participated in the EPIC trial ages 1–12 with newly acquired Pa, defined as either a first lifetime Pa positive respiratory culture or positive after two years of negative cultures (past isolation of Pa but >2 years prior to the trial). All received antibiotics to promote initial eradication followed by 15 months of intermittent maintenance antibiotics. Quarterly cultures were used to define initial eradication success and subsequent number of Pa recurrences. A standardized symptom-based definition of exacerbation was utilized. Cox proportional hazards models were used to estimate exacerbation risk.

Results Failure to initially eradicate Pa was associated with exacerbation risk (hazard ratio [HR]: 2.49, 95% confidence interval [CI] 1.26, 4.93). In 245/282 with successful initial eradication during the trial, past isolation of Pa >2 years before the trial was the most significant predictor of exacerbation (HR 1.62, 95% CI 1.12, 2.35). In 37/282 who failed initial eradication, persistent Pa during the maintenance phase (1 or more Pa recurrences after failure to initially eradicate) added even greater exacerbation risk (HR 4.13, 95% CI 1.28, 13.32).

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