Need for drainage/source control of head and neck infections should be evaluated carefully in consultation with Pediatric Otolaryngology, Head and Neck Surgery. If initial non-operative management is chosen, a narrow spectrum regimen (i.e. without vancomycin) is encouraged to facilitate transition to oral therapy.
ID consultation is recommended for head and neck infections occurring in immunocompromised patients, and for those with atypical features, chronic course, or lack of response to first line therapy.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Mastoiditis - acute, immunocompetent patient (<1 month duration) OR Subacute (duration >= 1 month) but with the following distinctions from chronic mastoiditis: Patient does not have history of a chronically non-intact tympanic membrane Patient does not have history of chronic suppurative otitis media |
Streptococcus pneumoniae Group A streptococcus Staphylococcus aureus |
Ampicillin-sulbactam (Unasyn) 50 mg ampicillin/kg/dose (max 2000 mg ampicillin/dose) IV q6h If patient has history of documented MRSA infection or carriage within the last 6 months: ADD Vancomycin (follow link for dosing & monitoring) |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Consult ID/ASP |
Urgent OHNS consult recommended to evaluate need for source control Consider ID consult (see details above) For confirmed or suspected intracranial extension, refer to Intracranial Abscess section for empiric therapy Therapy may be tailored based on cultures from I&D If Vancomycin was started and MRSA not recovered from drained abscess, discontinue Vancomycin Duration: Uncomplicated acute mastoiditis is typically treated first with IV therapy then converted to enteral therapy within days based on clinical improvement, with a total duration of 3-4 weeks (combined IV and enteral). A longer duration and more IV therapy is indicated for intracranial or other complications. |
|
Mastoiditis - chronic (months-years duration, arising as a complication of chronic suppurative otitis media, with chronically non-intact tympanic membrane) |
Variable depending on risk factors
|
Individualized treatment guided in consultation with OHNS |
OHNS consult recommended (management is primarily surgical) ID consult recommended if patient is presenting with new severe local symptoms and/or signs in the context of history of chronic mastoiditis, or if not responsive to usual management |
Reference:
American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.