Acute otomastoiditis in children: a scoping review on diagnosis and antibiotic regimens

The purpose of this study was to map current literature on the management of uncomplicated acute otomastoiditis (AM) with a focus on the antibiotic regimens and the role of imaging in diagnosis and complication detection. A systematic search was conducted across electronic databases for studies published between January 1, 2000 and May 31, 2025. Eligible studies included those involving pediatric patients under 18 years of age and published in English. The search adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) checklist. The literature search strategy yielded 9211 articles, of which 81 studies were included in this scoping review, involving a total of 11,919 patients. Most studies were observational or retrospective in design. Among the 66 studies (81.5%) reporting the use of CT imaging, 3795 out of 10,306 patients (36.8%) underwent CT scan whereas MRI use was not clearly reported. All patients were hospitalized and initiated on empirical parenteral antibiotic therapy, with third-generation cephalosporins being the most commonly prescribed agent. A shift from intravenous to oral antibiotic therapy was reported in 25 out of 81 (30.9%) studies. The overall duration of antibiotic therapy, including both IV and oral phases, ranged from 4 to 30 days. Conclusions: Our scoping review shows that all patients with AM receive long-lasting intravenous antibiotics and only some have an early oral shift, despite lack of evidence supporting this approach. The absence of high-quality clinical trials has led to significant variability in clinical practices. Large, prospective studies are needed to establish evidence-based guidelines and assess whether a more conservative approach, using oral antibiotics and shorter treatment durations, could be equally safe and effective for uncomplicated cases.