Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Acute Mastoiditis

Likely Pathogens

Streptococcus pneumoniae

Streptococcus pyogenes, GAS

H. influenzae (<10%)

S. aureus (<10%)

Empiric Therapy

if no CNS complications suspected:

Ampicillin IV

OR

Cefazolin IV

OR

Cefuroxime IV

Oral Step-down Therapy

Amoxicillin PO

OR

Amoxicillin-Clavulanate PO

OR

Cephalexin PO

If cultures taken

Once cultures are available, narrow the antimicrobial choice to target the isolated pathogen.

Usual Duration

10 - 14 days

May discharge on oral antimicrobials if adequate drainage and no cavernous sinus thrombosis, and clinically well.