From the Research
Skull base osteomyelitis is a life-threatening condition that requires aggressive treatment with prolonged intravenous antibiotics for 6-12 weeks, and the most recent evidence suggests that Hyperbaric Oxygen (HBO) therapy should be included in the treatment regimen. The recommended empiric antibiotic regimen includes anti-pseudomonal coverage with piperacillin-tazobactam 4.5g IV every 6 hours or cefepime 2g IV every 8 hours, plus vancomycin 15-20mg/kg IV every 8-12 hours (targeting trough levels of 15-20 μg/mL) to cover MRSA, as supported by 1. Once culture results are available, therapy should be narrowed, with Pseudomonas aeruginosa being the most common pathogen, particularly in diabetic or immunocompromised patients 1, 2.
Key Considerations
- Surgical debridement may be necessary for extensive disease or when there is no response to antibiotics, as noted in 3 and 4.
- Regular monitoring with inflammatory markers (ESR, CRP) helps track treatment response, and follow-up imaging with CT or MRI is recommended after 4-6 weeks of therapy, as suggested by 1 and 5.
- Patients typically require multidisciplinary management involving infectious disease specialists, otolaryngologists, and neurosurgeons, as emphasized in 1 and 2.
- The condition often presents with severe, persistent headache, cranial nerve deficits, and otologic symptoms, especially in patients with malignant otitis externa, as described in 1 and 5.
Recent Evidence
The most recent study, 2, published in 2024, highlights the importance of HBO therapy in the treatment of skull base osteomyelitis, with 87% of patients showing improvement and achieving regression in follow-up imaging. This suggests that HBO therapy should be considered as an adjunct to antibiotic treatment and surgical debridement, if necessary.
Treatment Approach
The treatment approach should prioritize early diagnosis, aggressive antibiotic therapy, and consideration of HBO therapy, as supported by the most recent evidence 2. By taking a comprehensive and multidisciplinary approach to treatment, patients with skull base osteomyelitis can achieve improved outcomes and reduced morbidity and mortality.