Outpatient management of acute mastoiditis with periosteitis in children

Children with acute mastoiditis with periosteitis are conventionally hospit alized for parenteral antibiotics and/or surgical treatment. However, if po ssible, effective and safe outpatient treatment is desirable. During a 36-m onth period, outpatient parenteral antibiotic therapy (once daily i.m. ceft riaxone) was evaluated in 32 children with acute mastoiditis, with clinical evidence of periosteitis. Inclusion criteria included otomicroscopic evide nce of acute otitis media (AOM), displacement of the pinna, retroauricular swelling, erythema and tenderness. The treatment consisted of wide myringot omy and administration of i.m. antibiotics. Daily visits, by a combined tea m of an otolaryngologist and pediatric infectious disease specialist, were considered essential. Fourteen children (43%) were treated initially in the hospital (and subsequently as outpatients) and 18 (57%) children were trea ted entirely as outpatients. Mean duration of outpatient treatment was 7 da ys (range: 4-10). The overall clinical cure rate was 96.8%. One child under went simple mastoidectomy. No serious side effects were observed. Our data suggests that many children with acute mastoiditis with periosteitis can be managed successfully and safely as outpatients by a combined team of otola ryngologists and infectious disease specialists. (C) 1998 Published by Else vier Science Ireland Ltd. All rights reserved.