Mastoiditis

Likely Pathogens

S. pneumonia

S. pyogenes (Group A strep)

S. aureus

Empiric Antibiotic Options

Cefotaxime 33 to 67 mg/kg IV Q8H

PLUS

Vancomycin 20 mg/kg IV Q6H

+/-

Metronidazole 10 mg/kg IV Q8H

Penicillin Allergy*

Cefotaxime 33 to 67 mg/kg IV Q8H

PLUS

Vancomycin 20 mg/kg IV Q6H

+/-

Metronidazole 10 mg/kg IV Q8H

*Avoid all beta-lactams antibiotics (ie cephalosporins, carbapenems) if anaphylaxis to penicillin

NOTE

Cefotaxime may be interchanged with ceftriaxone for pediatric patients if not receiving calcium containing IV products.

Ceftriaxone 80 to 100 mg/kg IV Q24H*

*For severe infections