Mastoiditis medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
The primary treatment for acute mastoiditis without [[osteitis]] is the administration of [[intravenous]] [[antibiotics]] after obtaining cultures.  The choice of antimicrobial agents is similar to that for [[otitis media|acute otitis media]]—antibiotics against ''[[Streptococcus pneumoniae]]'' and ''[[Haemophilus influenzae]]''.  Additional coverage for ''[[Staphylococcus aureus]]'' and [[Gram-negative bacilli]] may be considered for protracted disease until the results of cultures become available.<ref name="pmid18092706">{{cite journal| author=Ramakrishnan K, Sparks RA, Berryhill WE| title=Diagnosis and treatment of otitis media. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 11 | pages= 1650-8 | pmid=18092706 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18092706  }} </ref><ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages =  }}</ref>  [[Ciprofloxacin]] (500 mg twice a day) may be considered in [[immunocompromised]] patients with [[diabetes]] or [[HIV infection]] or in infections involving the skin and periauricular areas.  Long-term antibiotics may be necessary to completely eradicate the infection.  [[Otalgia]] associated with otitis externa may be managed with topical anesthesic agent such as [[benzocaine]].
===Antimicrobial Regimen===
===Mastoiditis===
*'''1. Acute Mastoiditis''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*'''1.1 Causative pathogens:'''
::*Streptococcus pneumoniae
::*Streptococcus pyogenes
::*Staphylococcus aureus
::*Hemophilus influenzae
::*Pseudomonas aeruginosa
:*'''1.2 Acute mastoiditis, outpatient'''
::*'''1.2.1 Empiric antimicrobial therapy'''
:::*Preferred regimen (no abx in past month): [[Amoxicillin]] 50 mg/kg/day PO q6h
:::*Preferred regimen (abx in past month): [[Amoxicillin-Clavulanate]] 90 mg/kg/day PO q12h {{or}} [[Cefdinir]] 14 mg/kg PO q24h {{or}} [[Cefpodoxime]] 10 mg/kg/day PO q12h (maximum dose is 400 mg/day) {{or}}  [[Cefprozil]] 30 mg/kg/day PO q12h (maximum dose is 1 g/day) {{or}} [[Cefuroxime]] 15 mg/kg/day PO q12h (Maximum dose is 1 g/day)
:::*Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days.
::*'''1.2.2 Pathogen-directed antimicrobial therapy'''
:::*'''1.2.2.1 Staphylococcus aureus (MSSA)'''
::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
:::*'''1.2.2.2 Staphylococcus aureus (MRSA)'''
::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
::::*Note: Maintain [[Vancomycin]] serum trough concentrations of 15-20 mcg/mL
:*'''1.3 Acute mastoiditis, inpatient'''
::*'''1.3.1 Empiric antimicrobial therapy'''
:::*Preferred regimen: [[Cefotaxime]] 1-2 g IV q4-8h {{or}} [[Ceftriaxone]] 1 g IV q24h
::*'''1.3.2 Pathogen-directed antimicrobial therapy'''
:::*'''1.3.2.1 Staphylococcus aureus (MSSA)'''
::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
:::*'''1.3.2.2 Staphylococcus aureus (MRSA)'''
::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
::::*Note: Maintain [[Vancomycin]] serum trough concentrations of 15-20 mcg/mL
*'''2. Chronic Mastoiditis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*'''2.1 Causative pathogens:'''
::*Polymicrobial
::*Enterobacteriaceae
::*Staphylococcus aureus
::*Pseudomonas aeruginosa
:*'''2.2 Empiric antimicrobial therapy'''
::*Preferred regimen: [[Imipenem]] 0.5 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4-6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q6h
::*Note: Treatment is reserved for acute exacerbations or perioperatively. It is recommended not to treat without surgical cultures


==References==
==References==

Revision as of 20:48, 21 June 2017

Mastoiditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Medical Therapy

The primary treatment for acute mastoiditis without osteitis is the administration of intravenous antibiotics after obtaining cultures. The choice of antimicrobial agents is similar to that for acute otitis media—antibiotics against Streptococcus pneumoniae and Haemophilus influenzae. Additional coverage for Staphylococcus aureus and Gram-negative bacilli may be considered for protracted disease until the results of cultures become available.[1][2] Ciprofloxacin (500 mg twice a day) may be considered in immunocompromised patients with diabetes or HIV infection or in infections involving the skin and periauricular areas. Long-term antibiotics may be necessary to completely eradicate the infection. Otalgia associated with otitis externa may be managed with topical anesthesic agent such as benzocaine.

Antimicrobial Regimen

Mastoiditis

  • 1. Acute Mastoiditis [3]
  • 1.1 Causative pathogens:
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Staphylococcus aureus
  • Hemophilus influenzae
  • Pseudomonas aeruginosa
  • 1.2 Acute mastoiditis, outpatient
  • 1.2.1 Empiric antimicrobial therapy
  • Preferred regimen (no abx in past month): Amoxicillin 50 mg/kg/day PO q6h
  • Preferred regimen (abx in past month): Amoxicillin-Clavulanate 90 mg/kg/day PO q12h OR Cefdinir 14 mg/kg PO q24h OR Cefpodoxime 10 mg/kg/day PO q12h (maximum dose is 400 mg/day) OR Cefprozil 30 mg/kg/day PO q12h (maximum dose is 1 g/day) OR Cefuroxime 15 mg/kg/day PO q12h (Maximum dose is 1 g/day)
  • Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days.
  • 1.2.2 Pathogen-directed antimicrobial therapy
  • 1.2.2.1 Staphylococcus aureus (MSSA)
  • Preferred regimen: Oxacillin 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
  • 1.2.2.2 Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
  • Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL
  • 1.3 Acute mastoiditis, inpatient
  • 1.3.1 Empiric antimicrobial therapy
  • 1.3.2 Pathogen-directed antimicrobial therapy
  • 1.3.2.1 Staphylococcus aureus (MSSA)
  • Preferred regimen: Oxacillin 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
  • 1.3.2.2 Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
  • Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL
  • 2. Chronic Mastoiditis[4]
  • 2.1 Causative pathogens:
  • Polymicrobial
  • Enterobacteriaceae
  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • 2.2 Empiric antimicrobial therapy

References

  1. ↑ Ramakrishnan K, Sparks RA, Berryhill WE (2007). "Diagnosis and treatment of otitis media". Am Fam Physician. 76 (11): 1650–8. PMID 18092706.
  2. ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
  3. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  4. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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