From the Guidelines
The treatment for mastoiditis typically involves hospitalization for intravenous antibiotics and possible surgical intervention, with a focus on broad-spectrum coverage against common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes, as recommended by recent guidelines 1.
Key Considerations
- Initial antibiotic therapy should include a third-generation cephalosporin (ceftriaxone 1-2g IV every 24 hours) combined with vancomycin (15-20 mg/kg IV every 8-12 hours) or clindamycin (600-900 mg IV every 8 hours) for 10-14 days, based on the most recent and highest quality study 1.
- Surgical intervention is often necessary, particularly in cases with complications or those not responding to antibiotics within 24-48 hours, with mastoidectomy being the primary surgical procedure, as reported in a review of 577 cases of AM from across Sweden 1.
- Pain management with acetaminophen or NSAIDs is also important, and regular follow-up is essential to ensure complete resolution and prevent complications such as hearing loss, facial nerve paralysis, or intracranial spread of infection.
Management Approach
- The algorithm developed by Chesney et al, which involves initiating treatment with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, and postponing computerized tomography (CT) scanning until after 48 hours or clinical deterioration, can be a useful guide for managing uncomplicated AM cases 1.
- The decision to use antibiotics or observe should be part of a larger management strategy that includes analgesics, parent information, and provisions for a rescue antibiotic, as emphasized in the study by McCormick et al 1.
Evidence-Based Recommendations
- The most recent and highest quality study 1 supports the use of broad-spectrum antibiotics and surgical intervention as needed, and highlights the importance of regular follow-up and pain management in the treatment of mastoiditis.
- The study by McCormick et al 1 provides additional evidence for the effectiveness of observation with a safety-net antibiotic prescription in select cases, but also emphasizes the need for careful patient selection and monitoring.
From the Research
Treatment for Mastoiditis
The treatment for mastoiditis can vary depending on the severity and complexity of the condition.
- Antibiotic therapy is the main treatment for non-complicated forms of mastoiditis, with cephalosporins being the antibiotic of choice due to the prevalence of Streptococcus pneumoniae 2.
- In cases of complicated mastoiditis, antibiotic treatment may be combined with other specific drugs, such as anticoagulants and/or corticosteroids 2.
- Surgical treatments, including incision of abscesses, mastoidectomy, and neurosurgical procedures, may be necessary in severe cases or when complications arise 2, 3, 4, 5.
Surgical Intervention
Surgical intervention is often required in cases of complicated mastoiditis, including:
- Subperiosteal abscess 3, 4, 5
- Intracranial complications 3, 4
- Coalescent mastoiditis 4
- Cases that do not respond to medical treatment within 48 hours 5
Medical Management
Medical management alone may be sufficient in non-complicated cases of mastoiditis, with: