Acute mastoiditis

First Line

Co-amoxiclav 1.2g IV 8 hourly

 

If previous Pseudomonas isolated from ear swabs:

Piperacillin-Tazobactam (Tazocin) 4.5g IV 6 hourly

Penicillin Allergy

Ceftriaxone 2g IV daily AND Metronidazole 500mg IV 8 hourly

 

Alternative or if previous Pseudomonas isolated from ear swabs:

Levofloxacin 500mg PO/IV 12 hourly AND Metronidazole IV 500mg 8 hourly 

(consider safety issues)

Notes

Treatment duration: 7-14 days. May require longer if severe/extensive infection