What are the recommended antibiotics for treating Mastoiditis (infection of the mastoid bone)?

From the Guidelines

Mastoiditis should be treated with intravenous Cloxacillin/Flucloxacillin at a dose of 50 mg/kg QDS for 10 days as the first line of treatment, as recommended by the World Health Organization 1. The choice of antibiotic is crucial in the management of mastoiditis, and the selected regimen should provide coverage against common pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, and anaerobes. Some key points to consider when treating mastoiditis include:

• The use of intravenous antibiotics to ensure adequate tissue penetration and coverage of the affected area
• The selection of an antibiotic regimen that is effective against the most common pathogens responsible for mastoiditis
• The importance of surgical intervention, such as mastoidectomy, in cases with complications or lack of improvement after 48 hours of medical therapy
• The need for culture-directed therapy when possible, using specimens from ear drainage or surgical procedures to guide targeted antibiotic treatment. In addition to Cloxacillin/Flucloxacillin, ceftriaxone IV can be considered as a second-line option 1. It is essential to note that the treatment of mastoiditis should be individualized based on the patient's specific needs and circumstances, and that consultation with an infectious disease specialist or an otolaryngologist may be necessary in complex cases.

From the Research

Mastoiditis Antibiotics

• The use of antibiotics in the treatment of mastoiditis is a common practice, with most patients receiving broad-spectrum intravenous antibiotic therapy 2, 3, 4.
• The choice of antibiotic depends on the causative organism, with Streptococcus pneumoniae, Streptococcus pyogenes, and Pseudomonas aeruginosa being common etiologies 3, 5, 4.
• In some cases, antibiotic treatment may not be effective, and alternative treatments such as bacteriophage therapy may be considered 6.
• The duration of antibiotic therapy can vary, with some studies suggesting that shorter courses (≤10 or ≤14 days) may be sufficient for some patients 4.
• However, the use of antibiotic stewardship is essential to ensure judicious use of antibiotics and prevent the development of antibiotic-resistant organisms 4.

Bacterial Spectrum

• The bacterial spectrum of mastoiditis can be affected by prior antibiotic treatment, with some studies suggesting that pneumococci and beta-hemolytic streptococci are more likely to cause mastoiditis than other pathogens 5.
• Gram-negative bacteria, such as Pseudomonas aeruginosa, can also cause mastoiditis, particularly in patients with underlying conditions such as cystic fibrosis 6.
• The use of broad-spectrum antibiotics may not always be effective against these organisms, highlighting the need for targeted antibiotic therapy 3, 4.

Treatment Protocols

• Treatment protocols for mastoiditis may vary, but most involve the use of broad-spectrum intravenous antibiotic therapy, with or without surgical intervention such as mastoidectomy 2, 3, 4.
• Early mastoidectomy may be recommended in cases where the infection fails to respond to antibiotic therapy, in order to prevent serious complications 2.
• The use of bacteriophage therapy may be considered in cases where antibiotic treatment is not effective, particularly in patients with multidrug-resistant organisms 6.