Pediatric Mastoiditis Medication

Updated: Nov 24, 2021
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD  more...
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Medication Summary

The principal medications used in the treatment of mastoiditis are antibiotics. Other medications include analgesics and antipyretics and topical antibiotic-steroid combinations. If open mastoid surgery is not undertaken, use of high-dose intravenous (IV) steroids is warranted to decrease mucosal swelling and promote natural drainage through the aditus ad antrum into the middle ear.


Antibiotics, Other

Class Summary

Culture and sensitivity results ultimately govern the selection of specific antibiotics. Until microbiologic information is available, the following principles guide selection:

- The antimicrobial must be appropriate to cover the most common invasive strains of bacteria in acute otitis media (AOM)

- The selected antibiotic should cross the blood-brain barrier

- The selected therapeutic spectrum should include consideration of multidrug-resistant S pneumoniae (MDRSP) organisms that are prevalent in the individual’s community

Coverage for anaerobic bacteria, as well as gram-negative aerobic bacteria and S aureus including methicillin-resistant S aureus (MRSA), are important in chronic mastoiditis. Specific microbiologic diagnoses should be treated with appropriate antibiotics.

Linezolid (Zyvox)

Linezolid prevents formation of functional 70S initiation complex, which is essential for the bacterial translation process. It is bacteriostatic against staphylococci.

Cefepime (Maxipime)

Cefepime is a fourth-generation cephalosporin. Its gram-negative coverage is comparable to that of ceftazidime, but it has better gram-positive coverage (comparable to that of ceftriaxone). Cefepime is a zwitterions and rapidly penetrates gram-negative cells. It is the best beta-lactam for intramuscular (IM) administration. Its poor capacity to cross the blood-brain barrier precludes its use for treatment of meningitis.


Because an increasing proportion of invasive strains of S pneumoniae are MDRSP and because MRSA is playing an increased role, beginning therapy with vancomycin is appropriate. After surgical or culture and sensitivity results confirm pathogenic sensitivity to other medications, medications that do not require the same degree of monitoring may be used instead. In patients with sensitivity to vancomycin, high-dose ceftriaxone or cefotaxime may be used. Rifampin is also effective in managing MDRSP.

The preferred method of administration is the individual analytic method. Adjust initial doses to provide peak levels of 25-40 µg/mL and trough levels below 10 µg/mL.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity. It arrests bacterial growth by binding to one or more penicillin-binding proteins. Initiate treatment with a high dose for adequate treatment of potential penicillin-resistant pneumococcal infection.

Meropenem (Merrem)

Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. It is effective against most gram-positive and gram-negative aerobic and anaerobic bacteria. Compared with imipenem, meropenem possesses slightly increased activity against gram-negative organisms and slightly decreased activity against staphylococci and streptococci.

Clindamycin (Cleocin)

Because an increasing proportion of invasive strains of S pneumoniae are MDRSP and because MRSA is playing an increased role, beginning therapy with clindamycin is appropriate. This agent is a lincosamide that is effective against S aureus, aerobic streptococci (except enterococci) and anaerobic bacteria. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Piperacillin and tazobactam sodium (Zosyn)

Piperacillin-tazobactam is a combination of an antipseudomonal penicillin with a beta-lactamase inhibitor. It inhibits biosynthesis of cell-wall mucopeptide and is effective during the stage of active multiplication. It is effective against aerobic and anaerobic gram-positive and gram-negative bacteria.


Antibiotics/Corticosteroids, Otic

Class Summary

After a tympanostomy tube is placed, with or without mastoidectomy, a pH-balanced solution or suspension of an antibiotic and a corticosteroid is useful to decrease mucosal swelling and to deliver topical antibiotics to the middle ear and mastoid. The drops should be continued until otorrhea has ceased and the view through the tube shows healing mucosa without swelling or obstruction. Several combinations are available; the best are those thin enough to apply through the tube into the middle ear.

Hydrocortisone/neomycin/polymyxin (Cortisporin, Cortomycin)

The combination of hydrocortisone with neomycin and polymyxin is an antibacterial and anti-inflammatory suspension for otic use. It is used to treat superficial bacterial infections in the external auditory canal.

Dexamethasone/tobramycin (TobraDex)

Tobramycin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane. Dexamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. This combination is available in sterile ophthalmic drops that are also commonly used for otic infections.

Gentamicin/betamethasone (Garasone)

The combination of gentamicin with betamethasone is supplied in a sterile ophthalmic solution available only in Canada. It is commonly used for otic infections. Gentamicin is an aminoglycoside antibiotic used for gram-negative bacterial coverage. Betamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.


Antibiotic, Otic

Class Summary

Otic antibiotics may be considered after tympanostomy tube placement to treat acute or chronic otitis media.

Ofloxacin otic solution

Ofloxacin inhibits bacterial growth by inhibiting DNA gyrase.