# Mastoiditis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) ## Treatment metadata - Ceftriaxone — 1000 mg — injection - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text MASTOIDITIS 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 against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Young children under two often present with irritability, fussiness, lethargy, fever, ear pulling, and ear pain [ear pain · fever · irritability · lethargy] - In adults, severe ear pain with fever and a headache is the typical complaint [ear pain · fever · headache] - It is almost always a complication of an acute middle ear infection - Children catch middle ear infections more readily, so they are the ones who get this - Red flag: left untreated it ends in meningitis, an abscess inside the skull, or a clot in a venous sinus [abscess] - Red flag: even now, one in ten children who reach those complications dies of them SIGNS - what you find (3) - Redness, tenderness, warmth, and fluctuance behind the ear with the auricle pushed forward [redness] - Otoscopy shows bulging of the back-upper canal wall and a bulging, pus-filled eardrum, sometimes ruptured and draining [pus] - A normal-looking eardrum usually, though not always, rules out acute mastoiditis TESTS (3) - CBC typically shows a raised white cell count with a left shift, plus raised ESR and CRP - CT can show loss of the bony walls between mastoid air cells - CT may show thickened or disrupted periosteum, or a collection beneath it (subperiosteal abscess) IF NOT THIS - what else fits (3) - Tumors mimicking mastoiditis are more often bilateral, involve cranial nerves, and less often cause fever - Cellulitis, otitis externa, lymphadenopathy, trauma, and tumor can all mimic acute mastoiditis - Rarely the air cells alone are infected, called incipient mastoiditis, or a grumbling middle ear gives the subacute form Source StatPearls "Mastoiditis" - disease-level clinical article Status traced to the source above Rx: Antibiotic | Main treatment ANTIBIOTIC 1. CEFTRIAXONE [1st line] Adult 1-2 g once daily by intravenous or intramuscular injection - Reviewed at 48 hours - failure to improve by then is an indication for mastoidectomy Peds 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.) 3kg -> 150-225 mg/dose 4kg -> 200-300 mg/dose 5kg -> 250-375 mg/dose 6kg -> 300-450 mg/dose 7kg -> 350-525 mg/dose 8kg -> 400-600 mg/dose 9kg -> 450-675 mg/dose 10kg -> 500-750 mg/dose 11kg -> 550-825 mg/dose 12kg -> 600-900 mg/dose 13kg -> 650-975 mg/dose 14kg -> 700-1000 mg/dose (upper capped) 15kg -> 750-1000 mg/dose (upper capped) 16kg -> 800-1000 mg/dose (upper capped) 17kg -> 850-1000 mg/dose (upper capped) 18kg -> 900-1000 mg/dose (upper capped) 19kg -> 950-1000 mg/dose (upper capped) 20kg -> 1000 mg/dose (capped) 21kg -> 1000 mg/dose (capped) 22kg -> 1000 mg/dose (capped) 23kg -> 1000 mg/dose (capped) 24kg -> 1000 mg/dose (capped) 25kg -> 1000 mg/dose (capped) 26kg -> 1000 mg/dose (capped) 27kg -> 1000 mg/dose (capped) 28kg -> 1000 mg/dose (capped) 29kg -> 1000 mg/dose (capped) 30kg -> 1000 mg/dose (capped) 31kg -> 1000 mg/dose (capped) 32kg -> 1000 mg/dose (capped) 33kg -> 1000 mg/dose (capped) 34kg -> 1000 mg/dose (capped) 35kg -> 1000 mg/dose (capped) 36kg -> 1000 mg/dose (capped) 37kg -> 1000 mg/dose (capped) 38kg -> 1000 mg/dose (capped) 39kg -> 1000 mg/dose (capped) 40kg -> 1000 mg/dose (capped) 41kg -> 1000 mg/dose (capped) 42kg -> 1000 mg/dose (capped) 43kg -> 1000 mg/dose (capped) 44kg -> 1000 mg/dose (capped) 45kg -> 1000 mg/dose (capped) 46kg -> 1000 mg/dose (capped) 47kg -> 1000 mg/dose (capped) 48kg -> 1000 mg/dose (capped) 49kg -> 1000 mg/dose (capped) 50kg -> 1000 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) Why 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. Caution 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. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)