Mastoiditis with Sub-Periosteal Abscess
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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)
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Clinical Diagnosis |
Antibiotics |
Duration |
Penicillin allergy |
Comments |
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Acute Otitis Media
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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. |
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Chronic Otitis Media |
Topical treatment |
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- Refer to ENT - Discuss with duty microbiologist or laboratory scientist considering systemic antibiotic |
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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
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Infection of Bone Anchored Hearing Aid (BAHA) implant |
Amoxicillin/clavulanic acid oral 625mg every 8 hours
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7-14 days then review
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Clindamycin oral 450mg 4 times daily
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