{ "schema_version": 1, "kind": "condition", "id": "mastoiditis", "name": "Mastoiditis", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class HD05.02 - condition scope only, no dose · Mastoiditis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560877/ · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255)", "verified_date": "2026-08", "treatments": [ { "id": 1121, "generic": "Ceftriaxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "1-2 g once daily by intravenous or intramuscular injection", "adult_duration": "Reviewed at 48 hours - failure to improve by then is an indication for mastoidectomy", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255)", "rationale": "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.", "cautions": [ "SEND THE PATIENT IN. The article says most patients with acute mastoiditis are admitted, and that a myringotomy with a grommet, or a mastoidectomy, may be needed alongside the antibiotic.", "REVIEW AT 48 HOURS. The article says mastoidectomy is indicated if mastoiditis has not improved by then, and warns that the clinical state can deteriorate quickly - serial examination, not one look.", "WHAT MAKES IT COMPLICATED, in the article's words: a large lesion behind the ear, bone erosion on imaging, high fever, or any neurological sign. Any of these and outpatient treatment is off the table.", "The article's own first choice for the inpatient without chronic otitis media is intravenous vancomycin alone, with an anti-pseudomonal drug added where there is a long history of ear infection. Neither the article nor the Egyptian formulary states a vancomycin dose, so no vancomycin row is printed here - that dose has to come from the admitting unit.", "Do not give to anyone with a known allergy to ceftriaxone or another cephalosporin. Never with an intravenous calcium-containing fluid in a baby of 28 days or under, and not in a jaundiced newborn." ], "peds_mgkg_low": 50.0, "peds_mgkg_high": 75.0, "peds_max_mg": 1000.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 500, "high_mg": 750, "capped": false }, { "weight_kg": 20, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 30, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 1000, "capped": true } ], "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "mastoiditis" }, { "id": 1122, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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.", "cautions": [ "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.", "RED FLAG - Swelling or redness behind the ear pushing it forward, high fever with systemic illness, or signs of intracranial spread such as severe headache, neck stiffness, or altered consciousness." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "mastoiditis" } ] }