Mastoiditis

1-2 g once daily by intravenous or intramuscular injection - Reviewed at 48 hours - failure to improve by then is an indication for mastoidectomy

50-75 mg/kg/dose [child max 1000 mg]

(Infants, children and adolescents, mild to moderate infection: 50-75 mg/kg as a single daily dose, maximum 1,000 mg a day. Severe infection: 100 mg/kg/day divided every 12 to 24 hours, maximum 4,000 mg/day.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255)

The cited article says antibiotics are the centrepiece of treatment, that most patients with acute mastoiditis are admitted, and that the uncomplicated patient with no significant history has been treated successfully as an outpatient on daily intravenous ceftriaxone with a low complication rate. The formulary's ceftriaxone monograph names acute otitis media - the infection mastoiditis grows out of - among its indications and gives the paediatric weight rule below. Antibiotics alone still leave an 8.5% complication rate in the article's figures, which is why this drug goes with a referral and not instead of one.

Acute mastoiditis is a potentially life-threatening suppurative complication of acute otitis media that requires immediate same-day hospital admission rather than outpatient oral antibiotic therapy. Key clinical signs include retroauricular erythema, warmth, fluctuant swelling (subperiosteal abscess), tenderness over the mastoid process, and outward/downward displacement of the pinna. Arrange urgent emergency transport for high-dose intravenous broad-spectrum antibiotics, urgent temporal bone CT imaging, and ENT surgical intervention (myringotomy, subperiosteal abscess drainage, or cortical mastoidectomy) to prevent lethal intracranial spread. - Refer, with advice

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

No dose - referral pathway, no medicine given in primary care

Acute mastoiditis is a potentially life-threatening suppurative complication of acute otitis media that requires immediate same-day hospital admission rather than outpatient oral antibiotic therapy. Key clinical signs include retroauricular erythema, warmth, fluctuant swelling (subperiosteal abscess), tenderness over the mastoid process, and outward/downward displacement of the pinna. Arrange urgent emergency transport for high-dose intravenous broad-spectrum antibiotics, urgent temporal bone CT imaging, and ENT surgical intervention (myringotomy, subperiosteal abscess drainage, or cortical mastoidectomy) to prevent lethal intracranial spread.