What is the treatment for mastoiditis?

From the Guidelines

The treatment for mastoiditis typically involves hospitalization for intravenous antibiotics and possible surgical intervention. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by effectively managing the infection and preventing complications. According to the American Academy of Pediatrics 1, initial antibiotic therapy should include broad-spectrum coverage against common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.

Key Considerations

• Common regimens include a combination of vancomycin (15-20 mg/kg IV every 8-12 hours) plus ceftriaxone (1-2g IV daily) or cefotaxime (2g IV every 4-6 hours) 1.
• Treatment duration is typically 10-14 days, often starting with IV antibiotics and transitioning to oral antibiotics once clinical improvement occurs.
• Surgical intervention, particularly mastoidectomy, is frequently necessary to drain the infection and remove infected bone tissue.
• This becomes essential if there's no improvement with antibiotics within 24-48 hours, if complications develop, or if abscess formation is present.

Additional Measures

• Pain management with acetaminophen or NSAIDs is also important.
• The aggressive treatment approach is necessary because untreated mastoiditis can lead to serious complications including meningitis, brain abscess, facial nerve paralysis, or hearing loss.
• Follow-up care should include audiometric testing to assess for hearing loss and regular examinations to ensure complete resolution of the infection. As noted in the study by McCormick et al, as cited in 1, the decision not to give initial antibiotic treatment and observe should be part of a larger management strategy that includes analgesics, parent information, and provisions for a rescue antibiotic. However, in the case of mastoiditis, prompt and aggressive treatment is crucial to prevent serious complications.

From the Research

Treatment for Mastoiditis

The treatment for mastoiditis typically involves a combination of antibiotics and surgical interventions.

• Antibiotics such as ampicillin-sulbactam or ceftriaxone are commonly used to treat the infection 2.
• Myringotomy, which involves making a small incision in the eardrum to drain the infection, may also be performed 3.
• In some cases, mastoidectomy, a surgical procedure to remove the infected mastoid bone, may be necessary if medical therapy fails 3 or if complications such as subperiosteal abscess or intracranial complications occur 2, 4.
• Conservative therapy, which includes antibiotics and minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess, may also be effective in treating uncomplicated cases of mastoiditis 5, 6.

Surgical Interventions

Surgical interventions may be necessary in cases where medical therapy fails or if complications occur.

• Mastoidectomy is a surgical procedure that involves removing the infected mastoid bone and is often performed in cases where medical therapy fails or if complications occur 3, 2, 4.
• Myringotomy, which involves making a small incision in the eardrum to drain the infection, may also be performed in conjunction with antibiotics 3.
• Minor surgical procedures such as drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration may also be performed in some cases 5.

Conservative Therapy

Conservative therapy, which includes antibiotics and minor surgical procedures, may be effective in treating uncomplicated cases of mastoiditis.

• Antibiotics such as ampicillin-sulbactam or ceftriaxone are commonly used to treat the infection 2.
• Minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess may also be performed in conjunction with antibiotics 5.
• Conservative therapy has been shown to have high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, with cure rates of up to 95.9% 6.