Mastoiditis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
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. | 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. [[Antibiotics]] for acute mastoiditis must cover the most common bacterial pathogens: [[Streptococcus pneumoniae]], [[Streptococcus pyogenes]], and [[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 the [[Pseudomonas aeruginosa]]. Bacteria commonly should cover are [[Streptococcus pneumonia]], [[Group A streptococcus]], [[Staphylococcus 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 commonly should cover [[Pseudomonas aeruginosa]], [[Staphylococcus aureus]] and [[anaerobes]]. Antibiotics are [[Piperacillin-tazobactam]] or [[Piperacillin]], and [[Ofloxacin]] Otic Solution; add [[Vancomycin]] 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. Serial examination of the postauricular region, the [[tympanic membrane]]; monitoring for [[fever]], [[otalgia]], postauricular tenderness, erythema, swelling, fluctuance, or mass, and narrowing the external auditory canal, is necessary. | ||
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.Bacteria commonly should cover are Streptococcus pneumonia Group A streptococcus | |||
For chronic mastoiditis bacteria commonly should cover Pseudomonas aeruginosa, Staphylococcus aureus and | |||
Serial examination of the postauricular region, | |||
==Medical Therapy== | ==Medical Therapy== | ||
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Depends on the patient condition, antibiotic choices may be differs as follows: | Depends on the patient condition, antibiotic choices may be differs as follows: | ||
==== Acute mastoiditis (<1 month duration), immunocompetent patient ==== | |||
** Bacteria commonly should cover: | ** Bacteria commonly should cover: | ||
*** Streptococcus pneumoniae | *** Streptococcus pneumoniae | ||
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*** ADD Vancomycin 15mg/kg/dose IV q6-8h (initial max 1g/dose) for severe infection with adjacent complications, or suspicion of MRSA | *** 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: | ** Bacteria commonly should cover: | ||
*** Pseudomonas aeruginosa | *** Pseudomonas aeruginosa | ||
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=== Mastoiditis treatment follow up === | === Mastoiditis treatment follow up === | ||
Treatment response should be monitor via below items, searching for improvement: | Treatment response should be monitor via below items, searching for improvement: | ||
* Serial examination of the postauricular region, | * Serial examination of the postauricular region, the [[tympanic membrane]]; monitoring for [[fever]], [[otalgia]], postauricular tenderness, erythema, swelling, fluctuance, or mass, and narrowing the external auditory canal, is necessary. | ||
==References== | ==References== | ||
Revision as of 18:18, 30 June 2017
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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 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. 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. Bacteria commonly should cover are Streptococcus pneumonia, Group A streptococcus, Staphylococcus 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 commonly should cover Pseudomonas aeruginosa, Staphylococcus aureus and anaerobes. Antibiotics are Piperacillin-tazobactam or Piperacillin, and Ofloxacin Otic Solution; add Vancomycin 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. Serial examination of the postauricular region, the tympanic membrane; monitoring for fever, otalgia, postauricular tenderness, erythema, swelling, fluctuance, or mass, and narrowing the external auditory canal, is necessary.
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 [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 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
- Bacteria commonly should cover:
chronic mastoiditis (>= 1 month duration, usually non-intact tympanic membrane), immunocompetent patient
- Bacteria commonly should cover:
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Anaerobes
- Bacteria commonly should cover:
- 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
- Antibiotics
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, the tympanic membrane; monitoring for fever, otalgia, postauricular tenderness, erythema, swelling, fluctuance, or mass, and narrowing the external auditory canal, is necessary.
References
- ↑ 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.
- ↑ "Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF".