Mastoiditis and subdural empyema

Dr. Zhou presented an unsettling case of post-URI otitis progressing to strep pneumo mastoiditis and dural sinus empyema today. Some salient takeaways from the discussion on mastoiditis:

  • Treatment for mastoiditis should include coverage for skin flora, and consider vancomycin for intracranial extension or pseudomonal coverage if complicated or requiring hospitalization
  • early myringotomy for acute otitis media decreases incidence of complications
  • Thanks Dr. Chiovaro for finding a case series and a retrospective cohort study supporting the hypothesis that there is not a significant cross-reaction penicillin allergies and carbapenems.

Sodhi, Manica, Sandra S. Axtell, Joyce Callahan, and Raja Shekar. 2004. “Is It Safe to Use Carbapenems in Patients with a History of Allergy to Penicillin?” The Journal of Antimicrobial Chemotherapy 54 (6): 1155–57.

Cunha, B. A., N. S. Hamid, V. Krol, and L. Eisenstein. 2008. “Safety of Meropenem in Patients Reporting Penicillin Allergy: Lack of Allergic Cross Reactions.” Journal of Chemotherapy 20 (2): 233–37.