What is the most appropriate treatment plan for a patient with persistent otitis externa and no signs of infection after prolonged antibiotic use?

For a patient with persistent otitis externa who shows no signs of infection after prolonged antibiotic use, the most appropriate approach is to discontinue the antibiotics entirely. The use of antibiotics in this case can contribute to the disruption of the normal flora of the skin, potentially exacerbating the condition rather than providing any benefit. Continuing prophylactic antibiotics might not address the underlying issues and could lead to complications such as resistance or further irritation.

Considering the options provided, discontinuing the antibiotics would allow the ear environment to restore its natural balance, thus facilitating healing without the interference of medication that may no longer be needed. In cases where there is no overt infection, the focus should shift to other management strategies, such as keeping the ear dry, considering topical treatments, or evaluating for other underlying causes like allergies or eczema.

Conducting a skin swab culture of seemingly healthy tissue (not inflamed or infected) would not be very useful in this scenario since the culture may not yield relevant information regarding the ongoing symptoms. Similarly, obtaining a gallium scan is excessive and unnecessary for chronic otitis externa without signs of complicating factors.

In summary, the most appropriate treatment plan involves stopping the unnecessary use of antibiotics and exploring alternative treatments based on the patient’s specific symptoms and condition.