From the Guidelines
The treatment for acute mastoiditis typically involves hospitalization for intravenous antibiotics, with a recommended regimen of cloxacillin/flucloxacillin IV at 50 mg/kg QDS for 10 days, as suggested by the World Health Organization pocket book of hospital care 1.
Key Considerations
- Initial antibiotic therapy should include broad-spectrum coverage against common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.
- Surgical management, such as myringotomy with tympanostomy tube placement or mastoidectomy, may be necessary for more severe cases with abscess formation, intracranial complications, or failure to respond to medical therapy.
- Pain management with acetaminophen or NSAIDs is also important.
- Patients should be monitored closely for complications such as meningitis, brain abscess, or facial nerve paralysis.
Recent Guidelines and Studies
- A study from 2017 suggests that mastoidectomy rates vary between 29% and 93% of patients with mastoiditis, and that nonsurgical management with intravenous antibiotics, either alone or combined with myringotomy and TT insertion and/or needle aspiration of the subperiosteal abscess, is becoming more common 1.
- Another study from 2020 notes that needle aspiration can be performed for confirmation of diagnosis, but the subperiosteal abscess will often recur with needle aspiration alone, and that most published literature reports surgical management 1.
Recommendations
- Intravenous antibiotics should be started promptly, with a recommended regimen of cloxacillin/flucloxacillin IV at 50 mg/kg QDS for 10 days.
- Surgical management should be considered for more severe cases or those that fail to respond to medical therapy.
- Patients should be closely monitored for complications and managed accordingly.
From the Research
Treatment of Acute Mastoiditis
The treatment of acute mastoiditis typically involves a combination of medical and surgical interventions.
- Medical therapy usually consists of intravenous antibiotics, with the specific antibiotic regimen often guided by culture results or suspected pathogens 2, 3, 4.
- Surgical treatment may include procedures such as mastoidectomy, myringotomy with tube insertion, or abscess drainage, depending on the severity of the disease and the presence of complications 2, 3, 4.
Indications for Surgery
Surgery is often reserved for cases of complicated acute mastoiditis or when medical therapy alone is insufficient 3, 5, 4.
- Complications such as meningitis, facial nerve paralysis, or lateral sinus thrombosis may require surgical intervention 2, 4.
- The decision to perform surgery should be made on a case-by-case basis, taking into account the individual patient's condition and response to medical therapy 3, 5.
Outpatient Management
In some cases, acute mastoiditis can be managed on an outpatient basis, particularly for patients with uncomplicated disease 6.
- Outpatient parenteral antibiotic therapy, such as once-daily intramuscular ceftriaxone, may be effective in treating acute mastoiditis with periosteitis in children 6.
- Close monitoring by a combined team of otolaryngologists and infectious disease specialists is essential for successful outpatient management 6.
Treatment Outcomes
The cure rates for medical treatment, conservative surgery, and mastoidectomy in pediatric acute mastoiditis are generally high, ranging from 89.1% to 96.3% 5.