From the Research
Intravenous antibiotic therapy for mastoiditis should begin with a broad-spectrum regimen, such as ceftriaxone (1-2g IV every 24 hours for adults; 50-75 mg/kg/day for children) plus vancomycin (15-20 mg/kg IV every 8-12 hours for adults; 10-15 mg/kg IV every 6 hours for children), to ensure adequate coverage against potential resistant organisms, as recommended by the most recent study 1.
Key Considerations
- The main pathogen of acute mastoiditis is Streptococcus pneumoniae, followed by Streptococcus pyogenes, Haemophilus influenzae, and Staphylococcus aureus, as reported in 2.
- Complications can be extracranial, intratemporal, or intracranial, and have a serious clinical course, potentially life-threatening, highlighting the need for prompt and effective treatment 2.
- Surgical intervention with mastoidectomy may be necessary alongside antibiotics, particularly for complicated cases with abscess formation, facial nerve involvement, or intracranial complications, as suggested by 1.
Treatment Duration and Alternatives
- Treatment duration typically requires 2-3 weeks of IV antibiotics, followed by oral antibiotics based on culture results and clinical response.
- Alternative regimens include piperacillin-tazobactam (3.375g IV every 6 hours for adults; 100 mg/kg/dose of piperacillin component every 8 hours for children) or meropenem (1g IV every 8 hours for adults; 20 mg/kg every 8 hours for children), as mentioned in the example answer.
Importance of Recent Evidence
- The most recent study 1 provides the most up-to-date guidance on the treatment of mastoiditis, emphasizing the need for broad-spectrum antibiotic coverage and prompt surgical intervention when necessary.
- Earlier studies, such as 2, 3, 4, and 5, provide valuable insights into the microbiology and treatment of mastoiditis, but may not reflect the current standard of care.