Optimizing skull base osteomyelitis treatment: effectiveness of antibiotic therapy within a multimodal approach

Skull base osteomyelitis (SBO) is a potentially life-threatening condition requiring multimodal treatment, including antibiotic therapy, surgery, and hyperbaric oxygen therapy. This study aimed to evaluate the role and the effectiveness of antibiotic therapy in the management of SBO. A retrospective analysis was conducted on 52 adult patients treated for SBO at the Department of Otolaryngology between 2006 to 2025. The study focused on the selection, duration, and mode of antibiotic administration, guided by microbiological findings. Antibiotic regimes were tailored based on pathogen sensitivity, surgical intervention and hyperbaric oxygen therapy provided as indicated. Of the 52 patients, 75.0 % were male and 25.0 % female. The mean age was 70.6 years (SD=11.0). A total of 301 swabs and biopsy samples were collected; in 11.5 % of cases, pathogens were identified only via biopsy. Despite repeated sampling, no pathogen was found in 19.2 % of patients. One patient required 20 samples before Mycoplasma was identified. The average duration of intravenous antibiotics was 31.9 days. Surgery was performed in 71.2 % of patients, and 55.8 % received hyperbaric oxygen therapy. Pathogen-specific antibiotic therapy following tissue sampling is a cornerstone of SBO treatment. Accurate microbiological diagnosis and individualized antibiotic regimens are essential for effective multimodal management.