Mastoiditis with Sub-Periosteal Abscess

It is due to infection of the mastoid air cells in the middle ear, a complication of Chronic Suppurative Otitis Media. It presents as a fluctuant painful swelling on the post auricular area. The overlying skin is also inflamed.

Non-pharmacological treatment

Aspirate the swelling before incision and drainage, and then refer for mastoidectomy at a zonal/national hospital.

Pharmacological treatment (Antibiotics)

*Clinical Diagnosis*	*Antibiotics*	*Duration*	*Penicillin allergy*	*Comments*
Acute Otitis Media	Antibiotics should not be routinely prescribed for uncomplicated AOM. *For severe disease or when risk of complications:* *First line* Amoxicillin oral 500mg every 8 hours *Second* line Amoxicillin/clavulanic acid oral 625mg every 8 hours	5 days	Antibiotics should not be routinely prescribed for uncomplicated AOM. *For severe disease or when risk of complications:* *First line* Clarithromycin oral 500mg every 12 hours *Second* line Doxycycline oral 100mg every 12 hours AND Metronidazole oral 400mg every 8 hours	- Most cases are viral and self-limiting. - Antibiotics should be delayed for 2-3 days and patient re-assessed.
Chronic Otitis Media	Topical treatment			- Refer to ENT - Discuss with duty microbiologist or laboratory scientist considering systemic antibiotic
Acute mastoiditis	Amoxicillin/clavulanic acid IV 1.2g every 8 hours *Oral Step down:* Amoxicillin/clavulanic acid oral 625mg every 8 hours	10 – 14 days	Clindamycin IV 900mg every 8 hours AND Ciprofloxacin oral 500mg every 12 hours *Oral Step down:* Clindamycin oral 450mg 4 times daily AND Ciprofloxacin oral 500mg every 12 hours	- IV to oral switch when clinically suitable (24 – 48hrs) - Review culture and sensitivity results - Assess for any bone and intracranial extension
Infection of Bone Anchored Hearing Aid (BAHA) implant	Amoxicillin/clavulanic acid oral 625mg every 8 hours	7-14 days then review	Clindamycin oral 450mg 4 times daily