From the Research
The recommended treatment for bilateral mastoiditis in an 11-year-old female includes immediate hospitalization for intravenous antibiotics, typically starting with a combination of ceftriaxone and clindamycin or vancomycin, with surgical intervention often necessary to drain middle ear fluid and remove infected mastoid bone. The treatment approach should prioritize covering common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes, as highlighted in the management of acute complicated mastoiditis 1.
Key Considerations
- Immediate hospitalization for intravenous antibiotics is crucial to prevent potentially life-threatening complications.
- Surgical intervention, such as myringotomy and tympanostomy tube placement, or mastoidectomy in more severe cases, is often necessary to drain middle ear fluid and remove infected mastoid bone.
- Pain management with acetaminophen or ibuprofen should be provided, and close monitoring of hearing and neurological status is essential.
Treatment Details
- Intravenous antibiotics, such as ceftriaxone (50-75 mg/kg/day) and clindamycin (30-40 mg/kg/day divided every 8 hours) or vancomycin (40-60 mg/kg/day divided every 6-8 hours), should be started immediately.
- Treatment typically continues for 10-14 days, with transition to oral antibiotics like amoxicillin-clavulanate (45 mg/kg/day divided twice daily) once clinical improvement occurs.
- The definition of uncomplicated mastoiditis, as proposed in a recent study 2, should be considered to guide treatment decisions and potentially reduce the need for lengthy antibiotic courses and surgical interventions in truly uncomplicated cases.
Complications and Monitoring
- Close monitoring of hearing and neurological status is essential, as complications can include hearing loss, facial nerve paralysis, or intracranial spread of infection.
- Bilateral mastoiditis is particularly concerning, requiring aggressive treatment to prevent potentially life-threatening complications, as it represents a serious complication of acute otitis media where infection has spread from the middle ear to the mastoid air cells on both sides 3, 1.