What is the treatment for bilateral mild mastoiditis in an adult inpatient with diabetes mellitus (Diabetes)?

From the Guidelines

For bilateral mild mastoiditis in an adult inpatient with diabetes, the recommended treatment is intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, as this approach has been shown to be effective in managing the condition while minimizing the need for surgical interventions like mastoidectomy 1.

Treatment Approach

The treatment should focus on:

• Intravenous antibiotics for 7-10 days, typically:
  • Ceftriaxone 2g IV every 24 hours, plus
  • Vancomycin 15-20 mg/kg IV every 12 hours (dose adjusted based on levels)
• Pain management with acetaminophen or NSAIDs as needed
• Nasal decongestants (e.g., oxymetazoline nasal spray) for 3 days maximum
• Close monitoring of blood glucose levels and adjustment of diabetes medication as needed
• Daily otoscopic examination to monitor progress

Considerations for Management

• Consider myringotomy (incision in the eardrum) if there's no improvement after 48-72 hours of treatment, as suggested by Chesney et al's algorithm 1
• CT scan of temporal bones to assess extent of infection and rule out complications, especially if there's failure to improve or clinical deterioration
• Switch to oral antibiotics (e.g., amoxicillin-clavulanate 875/125 mg twice daily) for an additional 1-2 weeks after discharge if responding well This regimen targets common causative organisms including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and is necessary due to the patient's diabetic status, which increases the risk of complications and antibiotic-resistant organisms 1.

Key Points

• The patient's diabetic status increases the risk of complications, making close glucose monitoring crucial as the infection and antibiotics can affect blood sugar levels
• Imaging helps guide further management and detect potential complications like intracranial spread
• The approach of using intravenous antibiotics with possible myringotomy aligns with recent trends towards nonsurgical management of mastoiditis, reducing the need for mastoidectomy in many cases 1

From the Research

Treatment for Bilateral Mild Mastoiditis in an Adult Inpatient with Diabetes Mellitus

• The treatment for bilateral mild mastoiditis in an adult inpatient with diabetes mellitus is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, study 3 discusses the inpatient treatment of type 2 diabetes, highlighting the importance of individualized glucose-lowering strategies and glycemic targets in hospitalized patients with diabetes.
• Study 4 provides insights into the treatment of acute mastoiditis in children, including the use of antibiotics and surgical intervention, but does not specifically address adult patients with diabetes.
• Study 5 analyzes the national landscape of acute mastoiditis, including trends in treatment and complication rates, but does not provide specific guidance on treating adult inpatients with diabetes.
• Study 6 focuses on pediatric recurrent acute mastoiditis, identifying risk factors and insights into pathogenesis, but does not address the treatment of adult patients with diabetes.

Considerations for Adult Inpatients with Diabetes

• When treating adult inpatients with diabetes and bilateral mild mastoiditis, it is essential to consider their individual glucose-lowering strategies and glycemic targets, as well as potential comorbidities and complications 3.
• The choice of treatment, including antibiotics and surgical intervention, should be based on the patient's specific condition and medical history.
• Close monitoring of blood glucose levels and adjustment of treatment as needed is crucial to prevent hypoglycemic episodes and other complications 3.