amoxicillin-potassium-clavulanate-combination and Mastoiditis

Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention.. A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed.. The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage.. Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefprozil; Cefuroxime; Cephalexin; Cephalosporins; Child; Child, Preschool; Clindamycin; Cochlear Implantation; Cochlear Implants; Drainage; Female; Hearing Loss, Sensorineural; Humans; Infant; Infusions, Intravenous; Male; Mastoiditis; Otitis Media; Prosthesis-Related Infections; Retrospective Studies; Risk Factors

We report the case of a 5-month-old female infant who developed a progressive unilateral retroauricular swelling without further symptoms in the first 5 months of life. The otherwise healthy infant was breast fed and had no history of previous otitis media. The clinical suspicion of silent mastoiditis was confirmed by CT scans and the intraoperative finding of an abscess due to Streptococcus pneumoniae. The onset is unusual, since mastoid pneumatization develops only after birth, and it is presumed that maternal antibodies should protect the infant from serious infections within the first months of life.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Diagnosis, Differential; Drainage; Female; Humans; Infant; Infusions, Intravenous; Mastoid; Mastoiditis; Pneumococcal Infections; Tomography, X-Ray Computed

Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.. The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on 'antibiotic drugs' and 'bacterial resistance' during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained.. The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=-0.73 for the C-reactive protein test and -0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption.. Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.

Topics: Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Resistance, Bacterial; Drug Utilization; Fluoroquinolones; Mastoiditis; Penicillin Resistance; Pneumococcal Infections; Retrospective Studies; Slovenia; Streptococcus pneumoniae

The clinical features of actinomycosis affecting the ear, nose and throat are presented. One patient with actinomycosis of the ear suffering from mastoiditis and a Bezold abscess is discussed in detail. The disease is rare: only 10 patients with actinomycosis of the tympanomastoid area have been described in the English literature. The diagnosis is therefore often delayed. Effective treatment requires combined surgery and long-term chemotherapy.

Topics: Abscess; Actinomycosis; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Clavulanic Acids; Combined Modality Therapy; Drug Therapy, Combination; Humans; Male; Mastoiditis; Otorhinolaryngologic Diseases