From the Guidelines
The first-line antibiotic treatment for mastoiditis is intravenous ceftriaxone, as recommended by the World Health Organization 1. This is based on the most recent and highest quality evidence available, which suggests that ceftriaxone is an effective treatment for mastoiditis, particularly in cases where Streptococcus pneumoniae is the causative organism.
Key Considerations
- The choice of antibiotic should be guided by the suspected causative organism and local resistance patterns.
- Ceftriaxone is a third-generation cephalosporin with broad coverage against common causative organisms, including Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes.
- The recommended dose of ceftriaxone is 50-75 mg/kg/day for children and 2g IV every 24 hours for adults.
- Treatment duration is typically 10-14 days, with transition to oral antibiotics after clinical improvement.
- Surgical intervention with mastoidectomy may be necessary if there is no improvement within 24-48 hours of antibiotic therapy, or if complications develop.
Supporting Evidence
- A study published in the British Journal of Pharmacology in 2015 provides guidance on antibiotic prescribing for children in resource-poor settings, including recommendations for mastoiditis treatment 1.
- The World Health Organization pocket book of hospital care provides antibiotic generic recommendations, including ceftriaxone for mastoiditis treatment 1.
Clinical Implications
- The aggressive antibiotic approach is necessary because mastoiditis represents a serious infection of the mastoid air cells that can lead to intracranial complications if inadequately treated.
- Clinicians should be aware of the potential for complications, including meningitis, brain abscess, or venous sinus thrombosis, and monitor patients closely for signs of deterioration.
- Surgical intervention should be considered if there is no improvement within 24-48 hours of antibiotic therapy, or if complications develop.
From the Research
First-Line Antibiotic Treatment for Mastoiditis
The first-line antibiotic treatment for mastoiditis is typically a broad-spectrum intravenous antibiotic regimen, with cephalosporins being the antibiotic of choice due to the prevalence of Streptococcus pneumoniae 2.
Common Pathogens and Antibiotic Resistance
The main pathogens responsible for acute mastoiditis include:
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Haemophilus influenzae
- Staphylococcus aureus
- Pseudomonas aeruginosa 2, 3, 4, 5 There is a notable rate of antibiotic resistance, particularly among pneumococcal isolates, with 26.2% being resistant to penicillin or third-generation cephalosporins 4.
Treatment Approaches
Treatment approaches for acute mastoiditis may include:
- Intravenous antibiotic therapy alone 6, 4
- Myringotomy/tympanostomy in addition to antibiotic therapy 3, 6, 4
- Mastoidectomy in cases where the infection fails to respond to antibiotic therapy or in complicated cases 3, 6
- Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, may be necessary in severe complications 2, 6