Which is the most appropriate treatment for the elderly patient with otorrhea and granulation tissue in the external auditory canal?

• A. Amoxicillin
• B. Ciprofloxacin
• C. Doxycycline
• D. Cephalexin

Answer: (B)

Granulation tissue in the external auditory canal in an elderly patient points to malignant otitis externa, typically caused by Pseudomonas aeruginosa and capable of spreading to the skull base. Because of that, the treatment must cover Pseudomonas with an anti-pseudomonal antibiotic. Ciprofloxacin fits this need well, as it reliably fights Pseudomonas and penetrates bone and soft tissue, making it the best choice for this scenario. The other antibiotics listed lack consistent anti-pseudomonal activity, so they wouldn’t adequately treat this infection. Depending on severity, management may require IV therapy and ENT evaluation with imaging to assess for skull base involvement.