What is the treatment for mastoiditis?

From the Guidelines

Mastoiditis should be treated with intravenous antibiotics, such as ceftriaxone, and may require surgical intervention, including mastoidectomy, if complications develop or if there is no improvement after 48 hours of antibiotic treatment. The initial treatment approach involves administering intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, as suggested by Chesney et al 1. This approach allows for the postponement of computerized tomography (CT) scanning in uncomplicated cases, reducing unnecessary radiation exposure.

Key considerations in the treatment of mastoiditis include:

• The use of broad-spectrum antibiotics, such as ceftriaxone, to cover common pathogens, including Streptococcus pneumoniae 1
• The potential need for surgical intervention, including mastoidectomy, to drain the infection and remove infected bone 1
• The importance of pain management with acetaminophen or ibuprofen to ensure patient comfort and reduce the risk of complications
• Close follow-up to ensure complete resolution of the infection and to monitor for potential complications, such as meningitis, brain abscess, or hearing loss 1

It is essential to note that mastoiditis requires prompt treatment to prevent serious complications, and the treatment approach should be individualized based on the patient's clinical presentation and response to initial therapy 1.

From the Research

Treatment for Mastoiditis

• The treatment for mastoiditis typically involves antibiotic therapy, with the goal of targeting the causative organisms 2, 3.
• Studies have shown that the distribution of causative organisms in acute mastoiditis differs from that in acute otitis media, with Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa being common isolates 2, 3.
• The use of ceftriaxone as empiric antimicrobial therapy may not be sufficient in the post-pneumococcal conjugate vaccine era, due to increasing resistance of bacteria to antibiotics 3.
• Outpatient management of acute mastoiditis with periosteitis in children has been shown to be effective and safe, using once daily intramuscular ceftriaxone and daily visits from a combined team of an otolaryngologist and pediatric infectious disease specialist 4.
• Antibiotic treatment prior to surgical treatment can affect the bacterial spectrum, with pneumococci and beta-hemolytic streptococci being more likely to cause mastoiditis than other pathogens found in acute otitis media 5.

Antibiotic Options

• Ceftriaxone has been shown to be effective against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, but its use as empiric therapy may be limited by increasing resistance 3, 6.
• Other antibiotics, such as cefditoren, benzylpenicillin, ampicillin, cefotaxime, and meropenem, have also been studied for their effectiveness against common mastoiditis pathogens 6.
• The inoculum effect, where the minimum inhibitory and minimum bactericidal concentrations of an antibiotic increase with increasing inoculum size, has been observed with some antibiotics, such as benzylpenicillin and ampicillin against Haemophilus influenzae 6.