Treatment of Acute Mastoiditis with Brain Abscess or Epidural Abscess

Invasive acute mastoiditis can extend beyond the mastoid to cause life-threatening intracranial complications. This protocol addresses the specific high-acuity scenario of invasive acute mastoiditis complicated by epidural abscess or brain (parenchymal) abscess, with or without cerebritis.

Clinical Situation

This protocol applies when acute mastoiditis has become invasive and is associated with an epidural abscess or brain abscess, with or without cerebritis. Indications for consulting neurosurgeons include epidural brain abscess, parenchymal brain abscess, and sigmoid sinus thrombosis.

Treatment overview (partial): This scenario requires urgent multi-specialty coordination across neurosurgery, infectious disease, and ENT. Combination antibiotic therapy is initiated together with targeted laboratory workup — the full regimen, decision criteria, and clinical sequencing are contained in the protocol below.

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References

Epidural or brain abscess +/- Cerebritis

Indications for consulting neurosurgeons include epidural brain abscess, parenchymal brain abscess, and sigmoid sinus thrombosis.

Consult Pediatric Neurosurgery, ID and ENT

Vancomycin + Ceftazidime +/- Metronidazole (depending on clinical status)

Labs: Blood Culture; CRP/ESR

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