CSOM is very difficult to treat. Antibiotics and other topical therapies are good at inactivating the infection in the short term but often lead to medium term relapse. The Santa Maria Lab shows, in their Otology & Neurotology publication, that bacterial persisters are behind the relapse with current topical therapies unable to eradicate these. The cells have very low metabolic activity and survive antibiotic attack. They re-establish the infection after treatment has finished leading to cycles of infection. Repeated topical antibiotic therapies are likely to lead to long term development of bacterial resistance. Targeting these persister cells are critical for eradicating CSOM.
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