Antimicrobial Resistance in Chronic Suppurative Otitis Media: Current Challenges and Future Perspectives

Abstract

Chronic suppurative otitis media (CSOM) is a chronic inflammatory disease of the middle ear characterized by persistent or recurrent ear discharge through a perforated tympanic membrane. It remains a major public health problem, particularly in developing countries, and is associated with significant morbidity including hearing loss, speech impairment, poor scholastic performance, and intracranial complications. The emergence of antimicrobial resistance among bacterial pathogens causing CSOM has become an important therapeutic challenge worldwide. Common causative organisms such as Pseudomonas aeruginosa and Staphylococcus aureus increasingly demonstrate multidrug resistance due to irrational antibiotic use, incomplete treatment, biofilm formation, and widespread empirical therapy. Biofilm-associated infections contribute significantly to chronicity and treatment failure. Increasing resistance to fluoroquinolones, cephalosporins, and aminoglycosides has limited the effectiveness of conventional therapies. Culture-guided antimicrobial therapy and antimicrobial stewardship are therefore essential for effective management. Recent advances including anti-biofilm agents, bacteriophage therapy, and nanotechnology-based drug delivery systems show promising future potential. This review discusses the epidemiology, microbiology, mechanisms of antimicrobial resistance, diagnostic approaches, current treatment modalities, and emerging therapeutic strategies for antimicrobial-resistant CSOM.