Acute mastoiditis
ICD-10 H70.0 · ICD-11 AB11.0
Next-line protocol

When Initial Antibiotic Therapy Fails in Uncomplicated Acute Mastoiditis with Fluid in the Mastoid Air Cells

This protocol addresses patients with uncomplicated acute mastoiditis — a non-invasive presentation with fluid in the mastoid air cells and no history of severe allergy (anaphylaxis) to penicillins — whose condition has not responded to the initial antibiotic regimen within the expected window.

Clinical scenario

Uncomplicated acute mastoiditis · Non-invasive (fluid in mastoid air cells) · No history of severe penicillin allergy (anaphylaxis)

Escalation trigger — previous line did not achieve its goal

Initial management with Ceftriaxone (intravenous), with the planned transition to oral antibiotics upon improvement, failed to produce clinical improvement within 48–72 hours. This lack of expected response at the 48–72 hour mark is the threshold that triggers escalation to the present protocol.

Next-line approach — partial overview

After failure of initial intravenous antibiotic therapy, the structured next step in this scenario involves specialist-level evaluation and guidance. The full protocol details the specific clinical pathway to follow at this stage.

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References
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