<s>[INST] context: Rapidly spreading infection of external auditory canal, seen in diabetic patient with involvement of bone and presence of granulation tissue point towards malignant otitis externa as the diagnosis. Treatment Includes correction of immunosuppression (when possible), local treatment of the auditory canal, long-term systemic antibiotic therapy, and in selected patients, surgery: In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. IV antibiotics is directed against the offending organism. For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonal penicillin or cephalosporin (3rd generation piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibotic e.g. ciproflaxacin plus a glucocoicoid is also used. Extensive surgical debridement once an impoant pa of the treatment is now rarely needed. [/INST] question: An old diabetic male presented with rapidly spreading infection of the external auditory canal with involvement of the bone and presence of granulation tissue. The drug of choice for this condition is: | options: A: Ciprofloxacin B: Penicillin C: Second generation cephalosporin D: Aminoglycosides | answer: B </s>