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: Mehrian Jafarizade, M.D [2]

Overview

Medical treatment for acute and subacute mastoiditis without intracranial complications is intravenous antibiotics and myringotomy. Bacteria that should be commonly covered 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 covered are 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.

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 in 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 done.

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

Acute mastoiditis (<1 month duration), immunocompetent patient

Bacteria commonly should cover Streptococcus pneumonia, Group A streptococcus, 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 should cover Pseudomonas aeruginosa, Staphylococcus aureus, Anaerobes.

• Preferred regimen (1): Piperacillin-tazobactam (Zosyn) 100mg/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 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.