Mohamad Reza Afzalzadeh - Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

This systematic review determined the main antimicrobial agents resulting in MOEand spectrum antimicrobial therapy covering drug resistance in the disease. All thearticles published in three electronic databases, including PubMed, Web of Science,and MEDLINE, were searched within November ۱۵ to December ۱۵, ۲۰۲۰. Eventually,۲۷ reports were identified assessing the clinical outcomes of patients with MOE.Generally, the mean age of patients with MOE in different studies was within therange of ۵۹–۸۲ years, and the male/female ratio was ۱.۸:۱. The frequency of diabetesamong patients with MOE was within the range of ۴۰%-۱۰۰%, and the frequency offacial nerve involvement was up to ۶۰.۷% in various studies. Pseudomonas aeruginosais the most commonly reported causative organism in MOE. Methicillin-resistantStaphylococcus aureus is another organism leading to MOE. The main concerningissue in antibiotic therapy is the increasing isolation of bacterial strains resistant tothis therapeutic approach. Generally, patients undergoing initial combination therapyhave better outcomes compared to those receiving single therapy. Furthermore, therisk of ciprofloxacin resistance increased, especially when used as a monotherapyagent. The early diagnosis and treatment of patients with MOE are very crucial. Inthis regard, it is necessary to consider the management of diabetes for controllingthe infection with antibiotics and debridement of necrotic tissue. Aggressive surgicalmanagement is suggested in some patients with MOE.

Diabetes, Facial Nerve Involvement, Malignant External Otitis, Pseudomonas aeruginosa