What is the treatment for mastoiditis?

From the Guidelines

Mastoiditis should be treated with a combination of intravenous antibiotics, such as ceftriaxone (2g IV daily) plus vancomycin (15-20 mg/kg IV every 12 hours) for 7-10 days, and surgical intervention if necessary, to prevent complications and ensure complete resolution of the infection. The primary treatment approach for mastoiditis involves:

• Intravenous antibiotics: The use of broad-spectrum antibiotics like ceftriaxone plus vancomycin is recommended for 7-10 days, as seen in the study by 1.
• Switch to oral antibiotics: After clinical improvement, transitioning to oral antibiotics like amoxicillin-clavulanate for an additional 1-2 weeks is suggested.
• Surgical intervention: If symptoms worsen or don't improve within 24-48 hours, a mastoidectomy may be necessary to drain the infection and remove infected bone, as indicated in the study by 1.
• Pain management: Using acetaminophen or ibuprofen as needed for pain and fever is recommended.
• Close monitoring: Regular follow-up appointments to assess improvement and potential complications are crucial.

This aggressive treatment approach is necessary because mastoiditis is a serious infection that can spread to surrounding structures, potentially leading to meningitis or brain abscesses, as highlighted in the study by 1. The antibiotics target common causative bacteria like Streptococcus pneumoniae and Haemophilus influenzae. Surgical intervention may be required to physically remove infected tissue and improve antibiotic penetration. Prompt treatment is crucial to prevent complications and ensure complete resolution of the infection, as emphasized in the study by 1.

Some key points to consider:

• The use of ceftriaxone and vancomycin as first-line antibiotics is supported by the study by 1.
• The decision to perform a mastoidectomy should be based on the severity of the infection and the patient's response to initial treatment, as suggested in the study by 1.
• Close monitoring and follow-up appointments are essential to assess the patient's progress and adjust the treatment plan as needed, as recommended in the study by 1.

From the Research

Treatment Options for Mastoiditis

• The treatment for mastoiditis typically involves a combination of antibiotic therapy and surgical intervention 2, 3, 4, 5, 6
• Broad-spectrum intravenous antibiotic treatment is usually initiated to control the infection 2, 5
• Surgical procedures such as myringotomy, tympanostomy, and mastoidectomy may be performed to drain the infection and prevent complications 2, 4, 5, 6
• The decision to perform surgery depends on the severity of the infection and the patient's response to antibiotic therapy 2, 4, 5

Antibiotic Therapy

• The use of pre-admission antibiotic therapy has been associated with a higher risk of complications in pediatric acute mastoiditis 3
• The recommended duration of oral antibiotic therapy following hospital discharge is 10 days for uncomplicated cases 3
• Third-generation cephalosporins and amoxicillin-clavulanic acid are commonly used antibiotics for treating mastoiditis 5

Surgical Intervention

• Mastoidectomy is a common surgical procedure performed to treat mastoiditis, especially in cases where the infection is severe or not responding to antibiotic therapy 2, 4, 5, 6
• Wide mastoidectomy with broad attic exposure and posterior tympanotomy may be effective in preventing recurrent acute mastoiditis episodes 6
• Myringotomy and tympanostomy are also performed to drain the infection and relieve pressure in the middle ear 2, 4, 5

Recurrent Acute Mastoiditis

• Recurrent acute mastoiditis is a significant concern, with risk factors including history of recurrent acute otitis media and anatomic predisposition 6
• Streptococcus pneumoniae is a common bacteria isolated in cases of recurrent acute mastoiditis 6
• More aggressive surgical communication between the mastoid cavity and middle ear may be necessary to prevent recurrent episodes 6