Letters to the Editor
(i) Clinical microbiologists/physicians of the type suggested by D r Wilkins. (2) Scientifically-orientated microbiologists to develop the laboratory services, introducing modern techniques into diagnosis. (3) Experts in control of infection/epidemiology operating both in hospital and the community. Because infection is now a round-the-clock speciality, it is important that these persons are all members of one department and qualified to provide cross-cover for one another although each will have a prime field of interest. While infection problems arising in hospital are often handled in a less than optimal way, many of the advances already made in molecular biology and biochemistry have lain fallow due to the lack of time available to integrate them into diagnostic laboratories and outbreaks of infection continue to attract frequent and intense attention from the news media. Until microbiology departments have sufficient properly trained staff to do each job properly we shall continue to be plagued by plagues and developmental work will be retarded.
Department of Medical Microbiology The London Hospital Medical College Turner Street London Ez cAD, U.K.
S u c c e s s f u l t r e a t m e n t o f m a l i g n a n t otitis e x t e r n a w i t h oral c i p r o f l o x a c i n
Accepted for publication 29 June I989 Sir, We were interested to read the report from Osborne et al. (I989) on the treatment of a 35-year-old insulin-dependent diabetic patient, with malignant otitis externa, initially with intravenous ciprofloxacin (2oo mg b.d. for a week) and subsequently with oral ciprofloxacin (75o mg b.d. for 2 months), x T h e authors express reservations with respect to the efficacy of such a regimen in elderly, poorly controlled, diabetic patients with malignant otitis externa. We have recently reported the successful treatment of two such patients (aged 6I and 72 years) exclusively with oral ciprofloxacin. 2 T r e a t m e n t was continued for IO weeks and was accompanied by local debridement of the external auditory meatus. Both patients remain free of disease after a period of 8 months. We feel that oral ciprofloxacin represents a major advance in the management of malignant odds externa in terms of both economy and convenience for the patient.
Department of Ear, Nose and Throat Surgery Department of Microbiology St Thomas' Hospital London SEx 7EH, U.K.
S. A. Hickey S. J. Eykyn
References i. Osborne JE, Blair RL. Successful treatment of malignant otitis externa with oral ciprofloxacin. J Infect I989; I8: 298-299. 2. Hickey SA, Ford GR, Eykyn SJ, S6nksen, PH, Fitzgerald O'Connor, AF. Treating malignant ottis externa with oral ciprofloxacin. BMff I989; 299 (6698): 55o-55 I.