Mastoiditis medical therapy: Difference between revisions
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{{Mastoiditis}} | {{Mastoiditis}} | ||
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==Overview== | ==Overview== | ||
Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous [[antibiotics]] and [[myringotomy]]. [[Antibiotics]] for acute mastoiditis must cover the most common bacterial pathogens: [[Streptococcus pneumoniae|''Streptococcus pneumoniae'']], [[Streptococcus pyogenes|''Streptococcus pyogenes'']], and [[Staphylococcus aureus|''Staphylococcus aureus'']] (including [[Methicillin-resistant staphylococcus aureus|methicillin-resistant ''S.'' ''aureus'']]). The empiric antibiotics are [[Ampicillin-Sulbactam|ampicillin-sulbactam]] or [[ampicillin]]; add [[vancomycin]] for severe infection with adjacent complications or suspicion of [[MRSA]]. For [[chronic]] mastoiditis, bacteria common covered are [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']], [[Staphylococcus aureus|''Staphylococcus aureus'']] and [[anaerobes]]. Antibiotics include [[piperacillin-tazobactam]] or [[piperacillin]], and [[ofloxacin]] otic solution; add [[vancomycin]] for severe infection with adjacent complications or suspicion of [[MRSA]]. | Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous [[antibiotics]] and [[myringotomy]]. [[Antibiotics]] for acute mastoiditis must cover the most common bacterial pathogens: [[Streptococcus pneumoniae|''Streptococcus pneumoniae'']], [[Streptococcus pyogenes|''Streptococcus pyogenes'']], and [[Staphylococcus aureus|''Staphylococcus aureus'']] (including [[Methicillin-resistant staphylococcus aureus|methicillin-resistant ''S.'' ''aureus'']]). The empiric antibiotics are [[Ampicillin-Sulbactam|ampicillin-sulbactam]] or [[ampicillin]]; add [[vancomycin]] for severe infection with adjacent complications or suspicion of [[MRSA]]. For [[chronic]] mastoiditis, bacteria common covered are [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']], [[Staphylococcus aureus|''Staphylococcus aureus'']], and [[anaerobes]]. Antibiotics include [[piperacillin-tazobactam]] or [[piperacillin]], and [[ofloxacin]] otic solution; add [[vancomycin]] for severe infection with adjacent complications or suspicion of [[MRSA]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous [[antibiotics]] and [[myringotomy]]. With only antimicrobial therapy, there is a possibility | Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous [[antibiotics]] and [[myringotomy]]. With only antimicrobial therapy, there is a possibility that mastoiditis will lead to further complications. In a study of 223 patients with mastoiditis, 8.5 percent developed complications during antimicrobial therapy. If the disease course worsens with [[antibiotics]] and [[myringotomy]], [[surgical procedures]] may be performed.<ref name="pmid11165635">{{cite journal |vauthors=Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S, Joachims HZ, Goldenberg D |title=Acute mastoiditis--the antibiotic era: a multicenter study |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=57 |issue=1 |pages=1–9 |year=2001 |pmid=11165635 |doi= |url=}}</ref><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref> | ||
=== Empiric antibiotic therapy === | === Empiric antibiotic therapy === | ||
[[Antibiotics]] for acute mastoiditis must cover the most common bacterial pathogens: ''[[Streptococcus pneumoniae]], [[Streptococcus|Streptococcus pyogenes]]''[[Streptococcus|,]] and [[Staphylococcus aureus|''Staphylococcus aureus'']] (including [[Methicillin-resistant staphylococcus aureus|methicillin-resistant ''S. aureus'']]). If there is a history of recurrent [[acute otitis media]] or recent [[antibiotic]] usage, the intravenous [[antibiotic]] also should cover [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']]. Depending on the patient's condition, antibiotic choices may differ as follows:<ref name="pmid11165635">{{cite journal |vauthors=Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S, Joachims HZ, Goldenberg D |title=Acute mastoiditis--the antibiotic era: a multicenter study |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=57 |issue=1 |pages=1–9 |year=2001 |pmid=11165635 |doi= |url=}}</ref><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref> | [[Antibiotics]] for acute mastoiditis must cover the most common bacterial pathogens: ''[[Streptococcus pneumoniae]], [[Streptococcus|Streptococcus pyogenes]]''[[Streptococcus|,]] and [[Staphylococcus aureus|''Staphylococcus aureus'']] (including [[Methicillin-resistant staphylococcus aureus|methicillin-resistant ''S. aureus'']]). If there is a history of recurrent [[acute otitis media]] or recent [[antibiotic]] usage, the intravenous [[antibiotic]] also should cover [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']]. Depending on the patient's condition, antibiotic choices may differ as follows:<ref name="pmid11165635">{{cite journal |vauthors=Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S, Joachims HZ, Goldenberg D |title=Acute mastoiditis--the antibiotic era: a multicenter study |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=57 |issue=1 |pages=1–9 |year=2001 |pmid=11165635 |doi= |url=}}</ref><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref> | ||
==== Acute mastoiditis (<1 month duration), | ==== Acute mastoiditis (<1 month duration), immunocompetent patient ==== | ||
Bacteria commonly covered are:[[Streptococcus pneumonia]], [[Group A streptococcus]], [[Staphylococcus aureus|Staphylococcus aureus.]] | Bacteria commonly covered are: [[Streptococcus pneumonia|''Streptococcus pneumonia'']], [[Group A streptococcus|Group A S''treptococcus'']], and [[Staphylococcus aureus|''Staphylococcus aureus''.]] | ||
* Preferred regimen (1): [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] IV 50mg/kg/dose '''<u>ADD</u>''' [[Vancomycin]] 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of [[MRSA]] | * Preferred regimen (1): [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] IV 50mg/kg/dose '''<u>ADD</u>''' [[Vancomycin]] 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe [[infection]] with adjacent [[complications]], or suspicion of [[MRSA]] | ||
* Preferred regimen (2): [[Ampicillin]] IV q6h (max 2g ampicillin/dose) '''<u>ADD</u>''' [[Vancomycin]] 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of [[MRSA]] | * Preferred regimen (2): [[Ampicillin]] IV q6h (max 2g ampicillin/dose) '''<u>ADD</u>''' [[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) ==== | ==== [[Chronic]] mastoiditis (>= 1 month duration, usually non-intact tympanic membrane) ==== | ||
Bacteria commonly covered are: [[Pseudomonas aeruginosa]], [[Staphylococcus aureus]], [[anaerobes|anaerobes.]] | Bacteria commonly covered are: ''[[Pseudomonas aeruginosa]], [[Staphylococcus aureus]]'', and [[anaerobes|anaerobes.]] | ||
* Preferred regimen (1): [[Piperacillin-tazobactam]] (Zosyn) | * Preferred regimen (1): [[Piperacillin-tazobactam]] (Zosyn) 100 mg/kg/dose IV, '''<u>PLUS</u>''' [[Ofloxacin]] Otic Solution 10 drops to affected ear BID, '''<u>ADD</u>''' [[Vancomycin]] 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of [[MRSA]]. | ||
* Preferred regimen (2): [[Piperacillin]] q6h (max 4g piperacillin/dose) IV, '''<u>PLUS</u>''' [[Ofloxacin]] Otic Solution 10 drops to affected ear BID, '''<u>ADD</u>''' [[Vancomycin]] 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of [[MRSA]] | * Preferred regimen (2): [[Piperacillin]] q6h (max 4g piperacillin/dose) IV, '''<u>PLUS</u>''' [[Ofloxacin]] Otic Solution 10 drops to affected ear BID, '''<u>ADD</u>''' [[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. | [[Antibiotic]] selection and dosing may be modified after obtaining the results of culture and [[antibiotic]] sensitivity. | ||
=== Mastoiditis treatment follow up === | === Mastoiditis treatment follow up === | ||
Treatment response should be monitored | Treatment response should be monitored by: | ||
* Serial examination of the postauricular region | * Serial examination of the postauricular region and the [[tympanic membrane]]. | ||
* Development of symptoms, such as [[fever]], [[otalgia]], [[Postauricular inflammation and swelling|postauricular]] tenderness, [[erythema]], [[swelling]], fluctuance, or [[mass]], and narrowing the [[external auditory canal]] | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 22:39, 29 July 2020
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous antibiotics and myringotomy. Antibiotics for acute mastoiditis must cover the most common bacterial pathogens: Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus (including methicillin-resistant S. aureus). The empiric antibiotics are ampicillin-sulbactam or ampicillin; add vancomycin for severe infection with adjacent complications or suspicion of MRSA. For chronic mastoiditis, bacteria common covered are Pseudomonas aeruginosa, Staphylococcus aureus, and anaerobes. Antibiotics include piperacillin-tazobactam or piperacillin, and ofloxacin otic solution; add vancomycin for severe infection with adjacent complications or suspicion of MRSA.
Medical Therapy
Medical treatment for acute and subacute mastoiditis without intracranial complications consists of intravenous antibiotics and myringotomy. With only antimicrobial therapy, there is a possibility that mastoiditis will lead to further complications. In a study of 223 patients with mastoiditis, 8.5 percent developed complications during antimicrobial therapy. If the disease course worsens with antibiotics and myringotomy, surgical procedures may be performed.[1][2]
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 Pseudomonas aeruginosa. Depending on the patient's condition, antibiotic choices may differ as follows:[1][2]
Acute mastoiditis (<1 month duration), immunocompetent patient
Bacteria commonly covered are: Streptococcus pneumonia, Group A Streptococcus, and Staphylococcus aureus.
- Preferred regimen (1): Ampicillin-sulbactam IV 50mg/kg/dose ADD Vancomycin 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of MRSA
- Preferred regimen (2): 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)
Bacteria commonly covered are: Pseudomonas aeruginosa, Staphylococcus aureus, and anaerobes.
- Preferred regimen (1): Piperacillin-tazobactam (Zosyn) 100 mg/kg/dose IV, PLUS 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.
- Preferred regimen (2): Piperacillin q6h (max 4g piperacillin/dose) IV, PLUS 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 monitored by:
- Serial examination of the postauricular region and the tympanic membrane.
- Development of symptoms, such as fever, otalgia, postauricular tenderness, erythema, swelling, fluctuance, or mass, and narrowing the external auditory canal
References
- ↑ 1.0 1.1 Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S, Joachims HZ, Goldenberg D (2001). "Acute mastoiditis--the antibiotic era: a multicenter study". Int. J. Pediatr. Otorhinolaryngol. 57 (1): 1–9. PMID 11165635.
- ↑ 2.0 2.1 "Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF".