Will Unasyn (Ampicillin-Sulbactam) help treat mastoiditis?

From the Guidelines

Unasyn (ampicillin/sulbactam) can be an effective treatment option for mastoiditis, especially when caused by susceptible bacteria, as it inhibits bacterial cell wall synthesis and overcomes certain resistance mechanisms through the sulbactam component 1.

Key Considerations for Treatment

• The typical adult dose of Unasyn for mastoiditis is 1.5-3g IV every 6 hours, while children typically receive 100-200 mg/kg/day divided into 4 doses.
• Treatment duration usually ranges from 10-14 days, often starting with intravenous administration and potentially transitioning to oral antibiotics as the infection improves.
• Mastoiditis treatment frequently requires a multidisciplinary approach combining antibiotics with possible surgical drainage or mastoidectomy in severe or complicated cases.

Importance of Guided Treatment

• Treatment should be guided by culture results when available, as some bacteria may be resistant to Unasyn.
• Medical supervision is essential rather than self-treatment, as mastoiditis is a serious condition that can lead to complications like meningitis or brain abscess if not properly treated.

Recent Guidelines and Recommendations

• According to recent guidelines, such as those from the American Academy of Otolaryngology-Head and Neck Surgery, the treatment of mastoiditis may involve intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess 1.
• The use of Unasyn in treating mastoiditis is supported by its effectiveness against a range of bacteria, including those commonly causing this condition, as noted in studies on antibiotic treatments for infections like infective endocarditis 1.

From the FDA Drug Label

Ampicillin and sulbactam for injection is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed below.

The conditions listed below include: Skin and Skin Structure Infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli,* Klebsiella spp. * (including K. pneumoniae*), Proteus mirabilis,* Bacteroides fragilis,* Enterobacter spp.,* and Acinetobacter calcoaceticus. Intra-Abdominal Infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K. pneumoniae*), Bacteroides spp. (including B. fragilis), and Enterobacter spp. Gynecological Infections caused by beta-lactamase producing strains of Escherichia coli,* and Bacteroides spp. * (including B. fragilis*).

The FDA drug label does not answer the question.

From the Research

Unasyn and Mastoiditis

• Unasyn, a combination of ampicillin sodium and sulbactam sodium, is a broad-spectrum antibiotic that can be used to treat various infections, including those caused by beta-lactamase-producing bacteria 2.
• Mastoiditis is a serious infection of the mastoid air cells, often associated with otitis media, and can be caused by bacteria such as Streptococcus and Staphylococcus 3, 4.
• The treatment of acute mastoiditis typically involves intravenous antibiotics, and Unasyn (ampicillin-sulbactam) is one of the antibiotics that can be used 4.
• The success rate of antibiotic therapy alone for mastoiditis is around 24.6%, while the success rate of minor surgical procedures, including myringotomy and drainage, is higher, at 87.7% 5.
• It is essential to note that the causative organisms of mastoiditis can vary, and the distribution of these organisms differs from those found in acute otitis media 3.
• Given the potential severity of mastoiditis and the importance of appropriate antibiotic coverage, Unasyn may be a suitable option for treatment, especially when the causative organisms are susceptible to ampicillin-sulbactam 2.

Key Considerations

• The diagnosis of mastoiditis should be suspected in patients who fail treatment for otitis media or demonstrate specific abnormalities on examination, such as tympanic membrane erythema, pinna protrusion, and postauricular erythema 4.
• Laboratory analysis and imaging studies, such as computed tomography (CT) of the temporal bones, may be necessary to confirm the diagnosis and rule out complications 4.
• The management of mastoiditis may involve a combination of medical and surgical interventions, and the choice of antibiotic therapy should be guided by the suspected or confirmed causative organisms 5.