Mastoiditis medical therapy

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

Medical Therapy

Medical treatment for acute and subacute mastoiditis without intracranial complications is intravenous antibiotics and myringotomy. With only antimicrobial therapy there is a possibility of progression of mastoiditis to further complications. In a study of 223 patients with mastoiditis, 8.5 percent developed complications during antimicrobial therapy

Empiric antibiotic therapy

Antibiotics for acute mastoiditis must cover the most common bacterial pathogens: Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus (including methicillin-resistant S. aureus). If there is a history of recurrent acute otitis media or recent antibiotic usage the intravenous antibiotic also should cover the Pseudomonas aeruginosa.

Depends on the patient condition, antibiotic choices may be differs as follows:

• Acute mastoiditis (<1 month duration), immunocompetent patient
  • Bacteria commonly should cover:
    • Streptococcus pneumoniae
    • Group A streptococcus
    • Staphylococcus aureus
  • Antibiotics:
    • Ampicillin-sulbactam 50mg/kg/dose
    • ampicillin IV q6h (max 2g ampicillin/dose)
    • ADD Vancomycin 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of MRSA

• chronic mastoiditis (>= 1 month duration, usually non-intact tympanic membrane), immunocompetent patient
  • Bacteria commonly should cover:
    • Pseudomonas aeruginosa
    • Staphylococcus aureus
    • Anaerobes

• • Antibiotics
    • Piperacillin-tazobactam (Zosyn) 100mg/kg/dose
    • Piperacillin IV q6h (max 4g piperacillin/dose)
    • AND Ofloxacin Otic Solution 10 drops to affected ear BID
    • ADD Vancomycin 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of MRSA

Antibiotic selection and dosing may be modified after obtaining the results of culture and antibiotic sensitivity.

Mastoiditis treatment follow up

Treatment response should be monitor via below items, searching for improvement:

• Serial examination of the postauricular region, and the tympanic membrane, fever, otalgia, postauricular tenderness, erythema, swelling, fluctuance, or mass. Narrowing the external auditory canal