Acute Mastoiditis with Severe Penicillin Allergy When Levofloxacin Has Not Achieved Clinical Improvement
This protocol applies to uncomplicated acute mastoiditis with fluid in the mastoid air cells (non-invasive) in a patient with a documented history of severe allergy (anaphylaxis) to penicillins, where the preceding levofloxacin course did not result in the expected clinical response.
Clinical Scenario
Uncomplicated acute mastoiditis, non-invasive (fluid confined to the mastoid air cells), in a patient who cannot receive penicillins due to a history of anaphylaxis. This excludes standard first-line penicillin-based options.
Prior Treatment — Failure Condition
The previous step used
Levofloxacin as an alternative in this penicillin-allergic patient. This protocol is indicated when the target of
clinical improvement within 48–72 hours was not met on that regimen.
Next Step (Partial Overview)
When levofloxacin has not achieved adequate improvement in this setting, escalation involves specialist consultation. The complete structured pathway for this scenario is available via the link below.
References
Acute Mastoiditis (uncomplicated)
Non-Invasive (fluid in mastoid)
For patients with a history of severe allergy (i.e. anaphylaxis) to penicillins, consider using levofloxacin at a dose of 10 mg/kg (max 500 mg) given BID for children <5 years old and once daily for children >5 years old.
Consult Pediatric Infectious Diseases
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