ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
Coverage against S. pneumoniae, S. pyogenes, S. aureus, H. influenzae
Clindamycin 600mg IV q8 hours OR (if MRSA concern use Vancomycin regimen)
Vancomycin 15-20mg/kg IV q12 hours PLUS
Ceftriaxone 1g (50mg/kg) IV once daily OR
Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hours
If chronic or severe, need pseudomonas coverage
Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
Ceftriaxone 1g (50mg/kg) IV once daily OR
Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hours
Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
Mastoiditis
Auricular hematoma
Acute otitis media
Auricular perichondritis
Sinusitis
Cholesteatoma
Labyrinthitis
Contact dermatitis