Acute Mastoiditis
S. pneumoniae, non-typeable H. influenzae, M. catarrhalis, S. pyogenes, MSSA/MRSA
Ceftriaxone 75mg/kg/dose IV q24h (max 2000mg/dose)
AND
Clindamycin 40mg/kg/day IV/PO div q8h (max 600mg/dose)¹
Penicillin Allergic Patients:
Levofloxacin
6 months to <5 years of age: 20mg/kg/day IV/PO div q12h (max 375 mg/dose)
5 years of age or older:
10mg/kg/day PO div q24h (max 750 mg/dose)⁷
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Consult Infectious Diseases, ENT.
ENT consultation is important, as many cases require debridement/drainage of infected middle ear fluid and the mastoid.
Recommend CT if high degree of suspicion for mastoiditis to assist with diagnosis and to assess for complications (sigmoid sinus thrombosis, subdural abscess, epidural abscess)
Length of Therapy (IV + PO): Typically, 4 weeks or greater, discuss PO transition and length of therapy w/Infectious Diseases.³