What is the treatment for Otomastoiditis?

From the Guidelines

The treatment for Otomastoiditis should involve a combination of broad-spectrum intravenous antibiotics, such as ceftriaxone, and possible surgical intervention, including mastoidectomy and myringotomy with tympanostomy tube placement, as outlined in recent guidelines and studies 1. The initial therapy for Otomastoiditis typically includes broad-spectrum intravenous antibiotics to cover common pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa.

• The choice of antibiotics may include ceftriaxone (1-2g IV daily) or a combination of vancomycin (15-20mg/kg IV every 8-12 hours) plus cefepime (2g IV every 8-12 hours) 1.
• This is usually continued for 10-14 days, followed by oral antibiotics for an additional 2-4 weeks. For severe cases or those not responding to antibiotics within 48-72 hours, surgical intervention is necessary, typically involving:
• Mastoidectomy to drain the infection and remove diseased tissue.
• Myringotomy with tympanostomy tube placement to drain middle ear fluid. Pain management with acetaminophen or NSAIDs is important for patient comfort.
• Prompt treatment is essential as Otomastoiditis can lead to serious complications including meningitis, brain abscess, facial nerve paralysis, or hearing loss if left untreated 1. The aggressive approach is necessary because the infection involves both the middle ear and mastoid air cells, with the mastoid's honeycomb structure making it difficult for antibiotics alone to completely eradicate the infection.
• Chesney et al developed an algorithm whereby in uncomplicated AM cases (without neurologic deficits or sepsis), computerized tomography (CT) scanning is postponed and treatment is initiated with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess 1.
• Failure to improve after 48 hours or clinical deterioration should prompt a CT scan to assess coexistent intracranial pathology, followed by mastoidectomy.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment for Otomastoiditis

The treatment for Otomastoiditis, also known as acute mastoiditis with periosteitis, typically involves a combination of antibiotics and surgical intervention.

• The antibiotics used may include amoxicillin, ceftriaxone, or other broad-spectrum antibiotics, depending on the severity of the infection and the patient's overall health 2.
• In some cases, outpatient parenteral antibiotic therapy may be effective, with daily visits from a combined team of an otolaryngologist and pediatric infectious disease specialist 2.
• Surgical treatment may involve wide myringotomy or simple mastoidectomy, depending on the severity of the infection and the patient's response to antibiotic therapy 2.

Antibiotic Treatment

The choice of antibiotic treatment for Otomastoiditis depends on various factors, including the severity of the infection, the patient's age and health status, and the likelihood of antibiotic resistance.

• Amoxicillin is often the first-line treatment for acute otitis media, but may not be effective against more severe infections or those caused by antibiotic-resistant bacteria 3, 4.
• Other antibiotics, such as ceftriaxone, trimethoprim-sulfamethoxazole, or ciprofloxacin/dexamethasone, may be used as alternative or adjunctive treatments, depending on the specific circumstances of the infection 3, 4, 5, 6.

Surgical Intervention

Surgical intervention may be necessary in cases where the infection is severe or does not respond to antibiotic therapy.

• Wide myringotomy or simple mastoidectomy may be performed to drain the infection and relieve pressure on the middle ear 2.
• Tympanostomy tubes may also be inserted to help drain the infection and prevent future episodes of otitis media 5.