Document Type : Systematic review


Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


This systematic review determined the main antimicrobial agents resulting in MOE
and spectrum antimicrobial therapy covering drug resistance in the disease. All the
articles published in three electronic databases, including PubMed, Web of Science,
and MEDLINE, were searched within November 15 to December 15, 2020. Eventually,
27 reports were identified assessing the clinical outcomes of patients with MOE.
Generally, the mean age of patients with MOE in different studies was within the
range of 59–82 years, and the male/female ratio was 1.8:1. The frequency of diabetes
among patients with MOE was within the range of 40%-100%, and the frequency of
facial nerve involvement was up to 60.7% in various studies. Pseudomonas aeruginosa
is the most commonly reported causative organism in MOE. Methicillin-resistant
Staphylococcus aureus is another organism leading to MOE. The main concerning
issue in antibiotic therapy is the increasing isolation of bacterial strains resistant to
this therapeutic approach. Generally, patients undergoing initial combination therapy
have better outcomes compared to those receiving single therapy. Furthermore, the
risk of ciprofloxacin resistance increased, especially when used as a monotherapy
agent. The early diagnosis and treatment of patients with MOE are very crucial. In
this regard, it is necessary to consider the management of diabetes for controlling
the infection with antibiotics and debridement of necrotic tissue. Aggressive surgical
management is suggested in some patients with MOE.