Ciprofloxacin 0.3% / Dexamethasone 0.1% ear drops

ObjectiveMultiple medical therapies exist to improve outcomes following surgical management of laryngotracheal stenosis. One method involves ciprofloxacin-dexamethasone (CPD) administration into the airway, although minimal information exists on this treatment. This scoping review evaluates the current literature to understand the potential utility of CPD after airway surgery.Data sourcesPubMed, EMBASE, Cochrane Library, Scopus, Web of Science.Review methodsDatabases were searched according to PRISMA guidelines. Studies were excluded if they did not administer CPD in the airway, were solely in vitro or animal studies, or lacked full text availability.ResultsFrom 1340 studies identified, seven met inclusion criteria, and one was added from manual searching. All eight articles were published between 2008 and 2025. Four described nebulized CPD, one discussed intratracheal drops, and three evaluated both. Four studies carefully evaluated CPD to assess efficacy and side effects across an aggregate of 167 pediatric and 53 adult patients. One group demonstrated fewer postoperative bronchoscopies and a shorter hospital stay after pediatric open airway surgery. Another study showed fewer granulation tissue events and earlier decannulation for pediatric tracheostomy patients. Side effects were infrequent, and three of the four groups reported no adverse events. In the fourth study, 4.5% of surveyed pediatric otolaryngologists observed a side effect from CPD.ConclusionAlthough there is a paucity of literature regarding the safety and efficacy of CPD use in the airway, the available data suggest low risks and potential benefits. Further research is needed to assess safety, optimal treatment regimens, and efficacy of this off-label therapy.

Abstract licence: CC BY-NC 4.0

In June 2022, a 73-year-old man with a history of laryngeal and esophageal carcinoma was admitted to the emergency unit with sudden fever, confusion, and general condition deterioration. Initial assessments showed a fever of 38.5 °C, elevated C-reactive protein (CRP) at 209 mg/L, and a neutrophil count of 10.4 G/L, with negative results for urine analysis, blood cultures, and multiple infectious pathogens, including Legionella pneumophila, pneumococcal antigen, and SARS-CoV-2. Computed tomography (CT) scans revealed no significant infectious focus. Empirical treatment with Ceftriaxone and Ciprofloxacin was initiated. Despite treatment, the patient’s condition remained unchanged, and a lumbar puncture revealed turbid cerebrospinal fluid (CSF) with 14,300 white blood cells (WBC)/mm³, predominantly neutrophils, elevated proteins, and decreased glucose. Gram staining suggested Neisseria meningitidis, but further testing was necessary. Antibiotic therapy was switched to Cefotaxime and Dexamethasone, and the patient was transferred to the Tropical and Infectious Disease Unit. Multiplex PCR assays and additional CSF tests were negative for common pathogens. Sequencing of 16S ribosomal RNA identified Gemella sp. The patient’s condition improved with continued Cefotaxime treatment, and he recovered without neurological sequelae. Subsequent dental CT revealed poor dental hygiene but no signs of osteo-meningeal breach or bone lysis. A literature review identified 22 reported cases of central nervous system (CNS) infections caused by various Gemella species from 1980 to 2022. Of these, 59% presented with meningitis, and 41% had additional encephalitis or brain abscesses. Complete recovery occurred in 77% of cases, with 9% resulting in neurological damage and another 9% in fatal outcomes. Relapses occurred in 14% of the cases. The review highlighted that CNS infections by Gemella spp. primarily affect immunocompromised adults with ENT (ear nose throat) or neurological breaches, although some cases involved healthy individuals. This case underscores the diagnostic challenges posed by uncommon pathogens like Gemella and highlights the utility of molecular microbiology in identifying causative agents, thus guiding appropriate treatment. The patient’s history of ENT and esophageal cancers, along with recent radiotherapy and chemotherapy, likely contributed to the infection’s development. The case emphasizes the importance of thorough investigation in febrile confusion cases and the potential role of Gemella spp. in CNS infections.

Abstract licence: CC BY-NC-ND