Mastoiditis medical therapy
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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:
Overview
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]
Empiric antibiotics for children with acute mastoiditis must cover the most common bacterial pathogens: S. pneumoniae, S. pyogenes, and S. 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 P. aeruginosa.
In a child with either no previous history of AOM or a history of a remote episode (ie, >6 months before), empiric antimicrobial therapy with vancomycin alone (60 mg/kg per day divided every 6 hours with a maximum dose of 4 gm/day) will suffice as empiric treatment until microbiologic results are available (table 1).
For children with a history of recurrent acute otitis media (most recent episode within six months) or recent antibiotic use, adequate coverage for gram-positive and gram-negative pathogens usually entails combination therapy (table 1). Additional antimicrobial agents may be warranted in patients with specific complications (eg, brain abscess) or if Gram stain of aspirated material demonstrates an unexpected finding. Antimicrobial therapy is adjusted as necessary when results of culture and susceptibility tests are available.
Upon diagnosis of the acute mastoiditis, initial antimicrobial typically is given intravenously. The patient can be switched to oral antibiotics when he or she has improved clinically and culture and susceptibility results are available [23-25]. In observational studies, the duration of treatment varies depending on the severity of the infection, with extended courses for children with intracranial complications [17,26]. We generally treat with intravenous antibiotics for 7 to 10 days and oral antibiotics to complete a four week course (the usual duration of infection for bone infection). (See "Hematogenous osteomyelitis in children: Management", section on 'Total duration'.)
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.